Chicago facility upends organizational chart

Decision making moves down the chart

The Rehabilitation Institute of Chicago (RIC) has adopted a new organizational structure designed to support its growing system of care. Under the new structure, the RIC system is divided into two operational divisions: the RIC Hospital and Clinics and RIC Corporate Partnerships. The Partnerships consists of joint ventures with other providers in the Chicago area and the Midwest.

The divisions are supported by the third component of the structure, Clinical Affairs, an integrated network of clinical and support departments designed to enhance the effectiveness and cost-efficiency of systemwide services. (See organizational chart, p. 43.)

"RIC of [the old structure] had just the hospital and clinics. We now have two lines of businesses. We have a complex organization that has grown over the years, and we needed to change the structure to meet the needs of the new organization," says Wayne M. Lerner, DPH, RIC president and chief executive officer.

One person in charge is not enough

The old structure depended on just one person, the chief executive officer or president, to know the rehabilitation business from many dimensions and to refine the programs and plan for growth. That concept is unrealistic in today's health care market, Lerner says. The new structure is designed to push decision making down the organization to the staff caring for individual patients.

That makes people more accountable for their actions because the areas of responsibility are more clearly defined, Lerner says. "The structure decreases the distance between an executive and the patients the institute cares for."

Before the new organizational structure was adopted, RIC already had shifted to interdisciplinary, team-based clinical management. An integral part of the new structure is the addition of five "levels-of-care experts" who will oversee each of RIC's five levels of care at the sites owned by the hospital and at those of its corporate partners.

The levels-of-care experts are in acute, subacute, outpatient, day rehabilitation, and home health rehabilitation services. "They will act as internal consultants, working with clinicians on planning, developing, and implementing new ideas and opportunities," Lerner says.

Levels-of-care experts will be familiar with payment issues, accreditation requirements, and federal and state legislative changes that affect their part of the continuum and will assist the individual treatment sites in meeting regulations.

"In the past, we have expected our clinicians to know about diseases and how to deliver care in addition to handling federal Health Care Financing Administration changes, as well as accreditation requirements from CARF . . . The Rehabilitation Accreditation Commission and Joint Commission on Accreditation of Healthcare Organizations. The world is getting complex enough to need people with special knowledge to provide support to direct caregivers," Lerner says.

Experts to work with staff

The levels-of-care experts, who were to be appointed this spring, will work with local staff to plan and implement new services, based on the needs of each site.

"The first thing it does is allow us to get a better handle on what our business really is. By establishing levels-of-care experts who really understand the nature of the business from many different perspectives, it gives us a better foundation of making decisions," Lerner says.

RIC's matrix organization is designed to bring research, education, and clinical support to every site. It makes the main hospital's expertise in areas such as outcomes, quality improvement, and research available to every individual affiliate.

The new structure also will allow for systemwide research, such as studying how spinal cord patients progress at multiple sites of care.

"Now the technology available in the area of practice is moving to such a degree that most of what we used to do in big academic centers can be done in the community," he says.

New structure means more support

The new structure gives the hospital the ability to provide corporate support such as human resources, financial support, and information systems to all sites. Where RIC has partnerships, the local executives work with RIC staff.

When Lerner arrived at RIC a year ago, he began meeting with the management team about the reorganization. After the management team worked out the new structure, the members met with the medical staff, which then began working under the new structure.

"We need to step back and look at the organizational structure and see if it allowed us to support the new way of doing business," he says.