A Case Study

Continued on page 2 The 1995 reorganization of the Veterans Health Administration into twenty-two Veterans Integrated Service Networks, or VISNs, created a significant opportunity to observe trends and innovations in healthcare delivery. One area where networks have substantially diverged has been in the development of service line structures. While some networks have moved forward rapidly in this area, others have utilized service lines only tangentially. The following case study is the second in a series of three Transition Watch articles in which we examine networks that have made the most extensive changes through implementation of service lines. All three networks featured in the series utilized service lines, although each network differed in the types of service line structures selected (e.g. teams, matrix or divisional forms) and in the manner in which service lines were deployed. VISN 10, the VA Healthcare System of Ohio and the subject of this case study, took a gradual path in service line implementation, moving through a number of organizational stages along the way. Similarly, VISN 13 (VA Upper Midwest Health Care Network) did not rapidly institute service lines, but rather approached their organizational changes in a more steady, step-wise progression. The subject of the first Transition Watch article in this series, VISN 2 (VA Healthcare Network Upstate New York), quickly implemented a service line structure that entrusted each network-level service line with a great deal of authority. The comparisons among these VISNs may be informative for those considering developing a service line structure.