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Dyad leadership teams will inevitably encounter disruptions to the social psychology of the ecosystem that is the clinical service line (CSL). Such disruptions often stem from the novelty of the care delivery design. The CSL is unconventional when compared with the traditions of hospital organizational models. CSL’s are designed to effectively manage specialized clinical care programming across sites and over time with effectiveness of: care coordination, patient experience and managed total costs of care as principal goals. The nature of the model and strategy is much more horizontal than vertical; meaning, its effectiveness depends upon the integration of care across location and time, whereas the conventional models of care delivery have historically been event or episode focused (a more vertical philosophy and structural orientation). When well executed, the patient experiences coordinated and seamless delivery of care; care organized systematically as compared with a care process that is a collection of “one-off” events. Simply stated, effective CSL models and method often fly in the face of how providers and managers would prefer things to work, including “who owns the patient”.

A central challenge for the CSL, Dyad leadership team is how to understand the “situational disorders” that stem from clashes of the old with the new, including the need for novel approaches to physician and provider services care model preferences and interacting incentives. There is a need for a useful “way of knowing and dealing with what is going on”; a framework for effective and efficient diagnosis and treatment planning and delivery for the CSL situational disorder (disruptions in the social psychology of the CSL “ecosystem”).

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