Deeply entrenched silos and boundaries have historically plagued healthcare organizations between departments, specialties, facilities, and sectors. While some separation by expertise is inevitable – and even necessary – excessive siloing often leads to miscommunication, fragmented and disjointed care, duplicated efforts, wasted resources, and potentially lost opportunities to serve patients and communities better.
With the healthcare industry continuing its relentless march towards value-based care and population health models, leaders across all organizations need to adopt a much more collaborative approach when it comes to actively dismantling silos through cultural and operational changes. This will need looking at healthcare delivery as an interconnected ecosystem rather than isolated parts.
Understanding the Causes and Impact of Silos
These damaging silos show up both within individual healthcare entities like hospitals and between different organizations across the broader care sector. Within hospitals, for example, rigid silos regularly exist between departments such as surgery, cardiology, neurology, oncology, emergency medicine, and more. Care teams can also become siloed by specialty, with limited coordination and communication between primary care physicians, specialists, nurses, rehab therapists, pharmacists, and other essential disciplines.
Outwardly, hospitals, physician groups, post-acute facilities, home health agencies, mental health consulting groups, social service organizations, community health centers, payers, and other players have historically operated in largely disconnected worlds. The mental health consultants behind Horizon Health say that this lack of connectivity, alignment, and collaboration often results in severe care fragmentation, gaps in supporting patients’ complete needs, breakdowns in care transitions and, ultimately, poor health and financial outcomes. And it is patients and families that suffer the consequences of this siloed dysfunction.
Several complex forces contribute to the formation of silos in healthcare. Some are:
- The legacy of fee-for-service payment models that rewarded volume over value and paid differently for different services.
- Distinct and misaligned reimbursement systems for various provider types and care settings that discourage collaboration.
- Slow adoption of interoperable health information technologies, data standards, and exchange platforms to share patient information seamlessly across entities.
- Lack of shared goals and accountability for collective population health outcomes and total costs.
- Persistent leadership mindsets centered on competition versus collaboration both within and between organizations.
- Regulatory barriers that sometimes impede partnerships between different types of providers.
While some of these drivers are progressively shifting, entrenched silos will not disappear without committed leadership deliberately designing integrated systems.
Strategies to Foster System-wide Collaboration
Healthcare leaders seeking to move their organizations and communities toward true integration should promote collaboration through strategies like:
- Actively breaking down departmental barriers by building cross-functional teams, vastly improving information flows, and explicitly linking departmental goals.
- Shifting to team-based interdisciplinary care models allowing fluid real-time collaboration between medical, behavioral, nursing, pharmacy, nutrition, social work, and other essential disciplines.
- Establishing open communication norms at all levels, through both formal and informal channels, to foster transparent discussion and sharing ideas across historical silos.
- Developing aligned incentives and shared goals regarding quality, experience, and total cost that tie rewards to collective outcomes across departments, facilities, and partner organizations.
- Making major investments in interoperable health data platforms and frameworks to exchange patient information seamlessly and securely across entities.
- Engaging diverse specialists and sites of care to jointly develop evidence-based clinical protocols, care pathways, and management guidelines customized to local needs.
- Forming deep strategic partnerships with community partners and social service organizations to address the underlying socioeconomic, behavioral, and environmental determinants of health.
Proactively employing such collaborative strategies means healthcare leaders can slowly but surely cultivate organizational cultures centered on communication, transparency, shared purpose and willingness to work together both within and across organizations for the greater good. While this shift poses profound challenges, breaking down entrenched silos is an absolute imperative for transitioning to truly integrated, high-value and sustainable models of care delivery.