Silos in the Healthcare Business – Conflicts versus Power
The meaning of silo is a trench, pit, or an especially tall cylinder, usually sealed to exclude air and used for making storing silage. Now apply this understanding to healthcare organizations, as a business model. So many of us talk about improving communications but fail to fix the silo factor. Have you ever worked in an organization that talked about how well they communicate with their employees? The communications problem could be many things such as the finance department does not know what the production departments are doing, social work does not know what recreation activity is doing, food service does not know what pharmacy is doing, and engineering does not communicate to anyone and just schedules repairs that interrupt daily events. I am not stating that this happens in all facilities, but I think you understand the concern.
Are department heads really trying to make things better or do these leaders just worry about what is in it for them when their stand-alone entity performs? A food service department is nothing without the patients, employees, visitors, etc. I think we may know the answer to our communications issues, but how do we solve this silo factor? The answer is that good communications is not a one-person or departmental function, but that it takes everybody in our organization realizing they have a role in an inter-related set of functions that must work together.
The reality is that it takes dollars to run our business. In healthcare accounting, the department heads do not know the organization’s current bottom line because there is usually a multi-month delay in reporting results. How can we plan appropriately? What are departments anyway? They were set up to do cost accounting and assign local accountability. This business strategy helps perpetuate silos, and therefore, communications barriers. The time has come to find creative accounting strategies and go to a department-less environment. We all have to be responsible and accountable for our organization’s success.
The other uncertainty is the amount of change we face each day. Change can perpetuate silos if not managed correctly. The meaning of change is to make a difference whether as an alteration, transformation, or a substitution. The problem with change is how we deal with the change, which all or parts of which may be out of our control. An example, let’s look at a hospital’s that decides to change its transport process to go from a centralized to decentralized model. The first thing we analyze in the decision process is what will the changes cost. Will this model save us money? Have we asked the employees affected what they think the best model will be? Involving all departments in the process of determining our strategy will lead to better results. Instead of an inclusive process, we frequently advise the individuals, in their silos, of leadership’s decision to make changes. This top down strategy leads to individualized reactions from the different silos, all uninvolved in the change process. Some individuals with strong morals and values stand by what they believe in, don’t support the changes, and eventually are pushed aside, others accept whatever happens, yet may not be all-in on commitment to the new business model.
With change, there is conflict and with new information, a spiraling of information. This new flavor of the month involves all levels of the organization, whether the department is directly or indirectly affected. To internalize change one needs to understand what happens during the process. There are four stages in the change process. First, there is disruption, which causes anxiety, silo protection, and personal pain. The second stage of the change process is the intensification, rush, and chaos to make the changes. This stage in the process is nerve racking. The time individuals need to accept or be willing to accept the consequences of the change is frequently not properly allocated. The third stage in the change process is the adaptation and evolution stage. This stage incorporates the formation of the change. What will the new model look like and how will we get there and in what timeframe. The fourth and last stage is the stability phase of change. Once there is acceptance, it does become easier, but does going through this change process always make it better? We need to focus more on what, we as individuals, need to accept, to make the new paradigm really work.
Healthcare organizational leaders have the responsibility to generate trust and a consistent vision. Focusing on the problems and delivering a message that is understood is a basic element of good communications. Leaders need to ensure that each person understands the mission and vision of the organization. As leaders, we need to walk the talk, literally. A portion of every day should be out in the field interacting with every level of the organization getting feedback and providing clear, honest communications.
The fundamental goal of an organization is to get things done collectively, and therefore, breaking down the silo factors.
The power of any organization comes from the guidance of the trustees, not just the short-term goals of finance or operational goals. There must not be a chasm between the highest level of leadership and any other part of our organization. The goal in healthcare is to create a culture that is accountable to quality care, safety and service to the community. There are two basic duties of any trustee for any healthcare organization: the duty of caring, and the duty of loyalty. By constantly keeping these duties in mind, trustees will have the framework to ask whether their decisions are in the best interests of their organization. The duty of loyalty guides trustees away from any potential conflicts. The trustee’s decisions on behalf of the organization must be made without the influence of personal interest or in the interest of other individuals or organizations. In theory, these elemental guidelines seem simple enough, but in practice, it can be quite complicated. How do we translate the highest level decisions across the organization and to our customers in a collaborative, effective approach?
The healthcare industry has an ethical responsibility that far exceeds other industries. Under the current system, some people perceive that administrators and physicians have no incentive to operate in a cost-efficient manner. The thinking within healthcare may too often be focused on institutional prestige versus the long term fiscal, and/or community based health needs. The balancing of the not-for profit and for-profit business models is fundamental for what is required to create the entrepreneurial sprit that is the drive behind a quality business. The reimbursement structure for healthcare providers is daunting with complex rules from the payers, such Medicare, Medicaid, managed care, and others. Not many industries have such a complex revenue stream that is positioned within a web of regulatory and political intricacy. Understanding MDS 3.0, rug rate, DRG, readmission rates, core measures, and other industry complications are daunting. We need to focus on those measures and actions that are accountable in that they lead to safe, high quality, sustainable results. Image a restaurant business trying to be successful in an environment where they do not set their prices for meals, while waiting months to get paid, maybe a percentage of what they thought they would receive. This is the norm in healthcare, which adds to the madness of the system.
The problem with heath care is that there are no perceived real owners. The political nature within the healthcare industry does not allow for an owners passion to deliver quality, safety, sustainability and profitability. There are healthcare organizations operating in a for-profit model. Unfortunately, the revenue formulas remain the same complex model as for the not-for-profit world. We need to create the critical mass of entrepreneurial thinking and pull together the needs of our customers, employees in a model of a community-centered healthcare system with a sustainable financial future. After all, we must all be the owners of the healthcare industry. Today’s patient may be the Queen of England, but tomorrow it may be your relative or mine.
The necessary approach for success in healthcare is to analyze issues as they constantly change, create effective workflows and teams, and develop an owner leadership mentality that generates collaboration and a culture of caring. We must evolve to link the customer, employee, and the sustainable and financial responsibilities of an organization. Silos need to go! We can do this. We allow our present environment, and we can change it.