Coordination
Duplicated Service Line
Duplicated Service Line is a Coordination scenario. The core lesson: When two campuses in the same health system both want to be the surviving site in a consolidation, the problem is not conflict over goals. Both sides want consolidation. The problem is a coordination failure over which campus wins it. A health system operating two hospital campuses 14 miles apart has determined that both run standalone cardiac catheterization programs with below-optimal case volumes. Strategic operations has concluded that consolidating both programs to one campus would reduce redundant equipment costs, improve per-operator volume, and strengthen program quality metrics. DecisionPlay maps the players, payoffs, and equilibrium dynamics that shape how this situation typically resolves.
The situation
A health system operating two hospital campuses 14 miles apart has determined that both run standalone cardiac catheterization programs with below-optimal case volumes. Strategic operations has concluded that consolidating both programs to one campus would reduce redundant equipment costs, improve per-operator volume, and strengthen program quality metrics. Both campus administrators submitted proposals on the same day, each arguing that their location, physician relationships, and payor mix make them the natural hub. The proposals are now sitting with the system CEO unresolved.
Background
Service line consolidation in multi-campus health systems is a coordination problem, not a conflict. The system benefits from any consolidation outcome. The cost is in failing to consolidate at all. But each campus has strong incentives to become the surviving site: program volume, physician loyalty, departmental budget, and institutional prestige. When both campuses submit simultaneous proposals without coordinating, they have converted a coordination problem into a competition. The system now has to pick a winner, which means creating a loser, which creates political resistance that delays or prevents the consolidation the system needs.
What this reveals
Why consolidation decisions stall at the last mile
Service line consolidation failures are almost always coordination failures, not disagreements about whether to consolidate. Both campuses agree the current duplication is inefficient. The impasse is about who bears the cost of being the non-surviving site. The COO who treats this as a competition to adjudicate will create a loser who resists implementation. The COO who treats it as a coordination problem to solve will find a structure where both campuses get something and neither has to fight the outcome.
How to counter it: Before issuing a consolidation decision, identify one meaningful initiative the non-surviving campus can lead. The 'what do we get?' question is what drives resistance. If it has a real answer, the opposition to the decision typically evaporates.
A question to sit with
In your system's last consolidation or rationalization decision, did the losing campus or department receive a compensating commitment, or were they simply notified?
Frequently asked questions
- What game theory concept does Duplicated Service Line illustrate?
- Duplicated Service Line illustrates Coordination. When two campuses in the same health system both want to be the surviving site in a consolidation, the problem is not conflict over goals. Both sides want consolidation. The problem is a coordination failure over which campus wins it.
- What is the situation in Duplicated Service Line?
- A health system operating two hospital campuses 14 miles apart has determined that both run standalone cardiac catheterization programs with below-optimal case volumes. Strategic operations has concluded that consolidating both programs to one campus would reduce redundant equipment costs, improve per-operator volume, and strengthen program quality metrics. Both campus administrators submitted proposals on the same day, each arguing that their location, physician relationships, and payor mix make them the natural hub.
- What does Duplicated Service Line reveal about how people decide?
- Why consolidation decisions stall at the last mile. Service line consolidation failures are almost always coordination failures, not disagreements about whether to consolidate. Both campuses agree the current duplication is inefficient. The impasse is about who bears the cost of being the non-surviving site. The COO who treats this as a competition to adjudicate will create a loser who resists implementation. The COO who treats it as a coordination problem to solve will find a structure where both campuses get something and neither has to fight the outcome.
- How do you avoid the trap in Duplicated Service Line?
- Before issuing a consolidation decision, identify one meaningful initiative the non-surviving campus can lead. The 'what do we get?' question is what drives resistance. If it has a real answer, the opposition to the decision typically evaporates.
- What is the research behind Duplicated Service Line?
- Service line consolidation in multi-campus health systems is a coordination problem, not a conflict. The system benefits from any consolidation outcome. The cost is in failing to consolidate at all.
- How long does Duplicated Service Line take to play?
- About 9 min, at advanced difficulty, across 1 decision points. It runs in your browser with no account and no sign-in.
Keep exploring
More Healthcare Ops scenarios, or browse all scenarios. New to this? Start with how DecisionPlay works or the game theory glossary.
Topics: service-line, consolidation, strategy, hospital-system