Service Lines, Neurology, and Academic Medicine: Departmental Perspectives, Implementation Strategies, and Keys to Success

Service lines are increasingly common for organizing multidisciplinary patient care. Concerns regarding impacts of neuroscience service lines were voiced at several national neurology department chair summits, prompting the American Academy of Neurology to convene a Service Lines Workgroup. Neurology department leaders nationally at institutions that had created or considered a neuroscience service line were interviewed to elicit their experiences and lessons learned. Potential benefits identified stemmed from additional resources that the service line structure yielded (patient navigators, quality improvement staff, technicians) and strengthening of cross-department collaboration. Potential pitfalls included top-down institutional decision-making regarding service line creation, lack of explicit goals, late involvement of neurology, imbalances in neurology representation in leadership, unclear impacts on department finances, and lack of education and research mission integration into service lines. Establishing a satisfactory decision-making structure in a matrixed arrangement and ensuring that funds flow allocations acknowledged neurology's "upstream"contributions were also challenges.