Silos in Healthcare

At its core, the idea of healthcare delivery is simple – it’s about one human being helping another heal or maintain a healthy life.

This simple idea gets complicated, though, as we layer on new technologies, lifestyles, institutions, policies, teams, processes, and business models. Creating an effective system of care in the US today is a problem that defies definition. It’s a case of the proverbial blind men trying to describe an elephant – where each person’s explanation is technically true but ultimately useless in creating a clear picture of the whole.

The resulting complexity leads many healthcare leaders to believe that it can be solved by breaking it down into small, specialized pieces – if only we had machines smart enough, data big enough, or analytical techniques sophisticated enough to do so. And indeed, most of our traditional institutions and companies are built to do just that.

Technology firms tout the latest and greatest diagnostic tools. Economists advocate policy ideas based on their ideological stance. Six Sigma ninjas attack hospital operations with the admirable aim of driving waste from the system. Behavioral scientists think up ingenious incentives to nudge us towards healthier habits. Traditional management consultants work with hard data, extrapolating historical trends to try and predict likely futures. All are worthy initiatives.


The Problems Plaguing Healthcare Are Highly Ambiguous.

If you take a step back and look at the bigger picture, though, is healthcare delivery in the US a clinical problem, a socio-economic problem, an education problem, a cultural problem, a process engineering problem, or a business problem? The only sane answer is, ‘All of the above!’

This makes healthcare delivery an ambiguous problem. Ambiguous problems span many domains, and cannot be solved by traditional specialists starting with hypotheses and seeking to prove or disprove them with data. This kind of thinking is what led to the siloed nature of healthcare in the first place.

Instead, we need a hybrid innovation strategy. That means first developing a deep empathy for the challenges real people face in their daily lives, to discover the real underlying problems that we need to solve. Then we need new ways to solve for those problems – cross-pollinating among diverse fields like social sciences, medicine, creative design, and business strategy.

Take any person in the US today who’s been through a hospital experience and they'll tell you that as most hospitals go, the right arm doesn’t know what the left arm is doing. Any number of doctors, residents, nurses, and staff may pass through the patient’s room in a day, but an individual staff member may not know who else examined a patient, let alone what they recommended.

The result, at best, is an exasperated patient. At worst, it can lead to a fatal procedure where a surgery team from one specialty – say cardiology – may not know of precautions that the pulmonologist had specified. We wish such cases were outliers, but in reality we know better. It happens regardless of the shine on a hospital’s brand name and reputation.

It would be easy to see this as just a coordination issue. And indeed, in some cases, process improvement folks using lean methods like process mapping and standardization have succeeded in making incremental improvements to health systems.

However, when our teams at Jump work with hospitals to create their next-generation care models, we routinely find deeper, more stubborn issues when we scratch the surface. For example, what is commonly thought of as a process problem may actually turn out to be cultural. A cardiologist may not communicate with a pulmonologist – not because of the lack of a process map – but because of egos and hoary old notions of how hierarchy exists in medicine.

There are many such unspoken drivers of behavior in healthcare – issues arising out of the mindsets, attitudes, culture, and education of patients, families, physicians, nurses, staff, and every human being involved in the entire process of care delivery. You won’t find them if you look in the EMR, in a CT scan, in an analyst report, in Powerpoint slides, in process maps, or in ‘big data.’ You would only find them if you walk the hallways of your hospital – in nurse’s stations, patient rooms, and doctors’ huddles – with a fresh pair of eyes and an open mind.

A New Type of Leader Is Called For.

In our lives and careers, many of us have been trained to trust certainty and distrust ambiguity. Our investors, shareholders, and boards dislike surprises and value predictable growth.

In the face of ambiguity, therefore, the knee-jerk reaction for most leaders can be to hunker down and stick to the familiar – keep the walls up between silos in their organizations.

That's a terrible way to grow the business at a time where the old approaches are not only failing but actively contributing to the problem. Throwing technology, marketing, and money at organizational problems is not a safe bet anymore.

For healthcare leaders today, the only way to address these ambiguous challenges, where business, culture, technology, and design are inextricably linked, is to take an approach to innovation that recognizes and fits the unique nature of these challenges.

At Jump, we call this approach Hybrid Strategy: working across silos, not in them. It means looking at business issues from a creative perspective, approaching design problems with rigorous analysis, and conducting research not just as experts but with a beginner’s mind. Hybridity is the silo-busting antidote to healthcare’s increasing ambiguity.

How would silo-busting show up in your health system? Here are 3 things to think about today:

  1. How can you help your physicians with time, incentives, and organizational “air cover” to compare notes and deliver care across their specialties?

  2. What are some ways to help patients and families “connect the dots” among their many touch-points in your system?

  3. How would you reduce hierarchy and empower lower-level providers or staff to ask difficult questions and even disagree with superiors when necessary?

By Kingshuk Das

Illustration by Jump's Owen Schoppe.