The second edition of this week’s “by request” blog is a request from Meredith Cooper. Meredith asked that I do a blog on “tearing down interdepartmental silos”. The topic came up after a management team meeting last week. We are in the middle of our strategic planning process and the management team assembled to perform a SWOT analysis. SWOT stands for Strengths, Weaknesses, Opportunities and Threats and the process allowed for the management team to evaluate the organization and list items under each of the headings. Under the weaknesses heading a great deal of discussion occurred regarding “departmental silos” in both the hospital and clinic.
Well Meredith, if I had a solution you would only see me on weekends because my weeks would be spent traveling the country providing hospitals the tools to tear down silos and increase teamwork which would allow me to bill consultant fees, become filthy rich and retire at age 40!
I don’t know that there’s an easy solution but before we can look for a solution we need to understand the problem. For you readers who are not hospital workers, and as a reminder for those who are, hospitals are divided into very distinct and specialized work units. Many health care careers involve specialized training. Only a nurse can be a nurse and only a nurse really understands what a nurse does. A radiology tech can’t do the work of a med tech and vice versa. A physical therapist doesn’t have the knowledge to work in engineering and a dietician can’t do wound care. Not only is training an issue but many of the services provided in a hospital are billable and Medicare and other payers require licensure and specific training requirements to be able to bill for services. So beyond education a therapist can’t bill for what a dietician does, a dietician can bill for what a nurse does and so on and so forth.
All of these areas of specialization in health care lend themselves to the creation of “interdepartmental silos”. Staff are well trained and very good at what they do and they are not good at, or even knowledgeable of, what others do. Every hospital in every city has the same problem.
I would suggest that the problem exists in other industry as well. When you go to Wal-Mart the person in the meat section can’t help you pick out good tomatoes or a high-definition television. At the auto dealership, the salesman might be able to explain the cars options but I’m not sure you want the salesman repairing your transmission.
In most industries people become specialized, segregated, and do what they know and rely on someone else to do the things they can’t. The same is true in health care the only difference is, we save lives, and the situations can be emotionally charged and we become less tolerant of others we depend on and in a small organization like GVMH, where staff know one another well, we tend to take advantage of one another and hold our co-workers to unreal expectations at times. It’s just like home, we all say things to, and expect things of, our spouse that we wouldn’t if he or she were a total stranger. At GVMH, for better or worse, our co-workers are like family.
The saying “walk a mile in my shoes” probably fits when looking for solutions to interdepartmental silos. We must first be willing to get outside of our own silos. It’s hard for all of us to venture outside of our comfort zone but in order to tear down silos we must first accept the fact that we are part of the problem. It would help to invite people from other departments into our own department. If the lab were to invite a couple of staff members from the emergency department to see what’s required after they collect blood from a patient in the emergency department and if lab staff were to go to the emergency department and see what happens from the time a patient comes through the door to the time lab is called to collect a specimen both groups may better understand how dependent they are on one another. If a group of nurses were invited to coding to see how their documentation is used to code charts and if a group of coders were invited to the patient floors to see the nurses process for documenting patient care each group may become more tolerant of the other. These are just a couple examples and I could list a hundred more.
So my solution to tearing down interdepartmental silos is to first acknowledge that each of us are part of the problem. The second step is to open our doors to others and invite them to see what we do and ask to see what they do.
Now if I can just get Meredith to pay me that consulting fee…