One of the overall goals of healthcare reform is to move from a fragmented healthcare system to an integrated model that provides services more efficiently and at less cost. Within hospitals, this fragmentation is seen in the different silos in which people work. Operating in silos threatens to prevent hospitals from delivering the coordinated care that is necessary to meet quality and cost demands of healthcare reform. In contrast, breaking down silos can help hospitals achieve coordinated care, which improves patient flow and the overall efficiency of the organization.
Mindset
"The fragmentation and variability associated with silo operations is the root cause of inefficiency and the biggest obstacle [to flow]," says Ben Sawyer, executive vice president of healthcare performance improvement company Care Logistics. He says one of the first steps in eliminating silos is changing the mindset of everyone in the hospital, from the CEO to the front-line workers. People need to move from department- to system-wide thinking about hospital operations to deliver care in a coordinated manner. While changing one's way of thinking after years of working under a different philosophy can be challenging, there are steps hospitals can take to work towards a silo-less organization.
"There needs to be a demand that you're trying to fulfill," says Imran Andrabi, MD, senior vice president and chief physician executive officer of Toledo, Ohio-based Mercy Health Partners and senior vice president of clinical innovation in the Office of Operations and System Effectiveness at Cincinnati-based Catholic Health Partners. "You must feel like the way we do business is not working or not sustainable — that something needs to be different." Recognizing a need for change, such as to reduce costs and improve quality, helps make hospitals more open to changing their mindset. "It's not necessarily fundamentally changing who you are, but maybe taking a few steps in a different direction to look at the same problem in a different way," Dr. Andrabi says.
Root cause
One of the key mindset changes necessary to break down silos is moving from a focus on immediate needs to a focus on key operational defects. Dr. Andrabi says that traditionally, the healthcare industry has focused on symptoms — such as overcrowding in an emergency department — instead of the root cause — such as inefficient processes in the ED. Overcrowding represents an urgent need: the hospital needs to better manage volume to ensure patient safety and maintain its market share. However, concentrating efforts on simply trying to see more patients faster ignores a possible upstream cause that may require an entire redesign of the ED process. Attacking the root cause of a problem is a more effective long-term solution than trying to eliminate the symptom and fosters coordination among silos. "If you get at one root cause, you may be able to get rid of a thousand symptoms," Dr. Andrabi says.
One of the reasons healthcare providers have historically been hesitant to address root causes is the conflict between urgent needs and important long-term deficiencies, according to Mr. Sawyer. He says that healthcare professionals resist going upstream to determine the root cause because they think leaving the immediate downstream work could result in fatal consequences. In the example above, the ED team may be concerned that taking the time to reassess their processes may put emergent patients in danger of not being seen, leading to potentially severe health outcomes. "It's a dilemma in the hospital system," Mr. Sawyer says.
One way hospitals can overcome this dilemma is to develop an infrastructure that allows providers to address root causes without sacrificing immediate patient needs. "Leaders can enhance the creation of an environment in which people can start taking their time away from urgent [tasks] and spend time thinking about the causal effects and important things in the organization," Dr. Andrabi says.
System aim
In addition to focusing on root causes, hospitals need to create a system aim to change mindsets towards breaking down silos. A system aim outlines the organization's primary goals and strategies on achieving those goals. Dr. Andrabi suggests hospital leaders "articulate that vision in such a way that people are willing to be part of it and can see what's in it for them — that they're not just doing it to make a change, but doing it to get a better outcome, better processes and a better environment in which people have the ability to do meaningful work."
Departments
Once hospitals begin to change their mindset, they need to work on fostering collaboration among departments to break down silos and improve patient flow. Efforts on improving patient flow need to involve the entire organization, because patients, staff and information travel between departments; they do not stay in separate silos. Optimizing flow in one department may not necessarily improve overall patient flow if the departments do not coordinate with each other. For example, Dr. Andrabi says a hospital lab reported having 96 percent of its labs on the charts by 8 a.m. In itself, this figure seems positive. However, looking beyond the department, Dr. Andrabi found that surgeons began rounding on their patients at 6:30 a.m. — making the lab's achievement less valuable.
"Hospital-wide coordination enables you to be in a situation where you are looking at the outcome and what needs to be done within the organization as a whole to be able to achieve that outcome," Dr. Andrabi says. Similar to shifting to root cause-thinking, moving from silos to coordinated departments marks a change from immediate needs to organization-wide needs. Considering the functions within the entire organization is key to making true improvements in patient flow.
One way Dr. Andrabi's team improved patient flow through department coordination was creating a partnership between the ED and critical care unit. When an ED patient was identified as potentially critical, a team of nurses from the intensive care unit would go to the ED to stabilize the patient there and then transport him or her to the ICU. This collaboration eliminated the step of ED nurses sending the patient to the ICU, which sped the process and improved patient outcomes.
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Mindset
"The fragmentation and variability associated with silo operations is the root cause of inefficiency and the biggest obstacle [to flow]," says Ben Sawyer, executive vice president of healthcare performance improvement company Care Logistics. He says one of the first steps in eliminating silos is changing the mindset of everyone in the hospital, from the CEO to the front-line workers. People need to move from department- to system-wide thinking about hospital operations to deliver care in a coordinated manner. While changing one's way of thinking after years of working under a different philosophy can be challenging, there are steps hospitals can take to work towards a silo-less organization.
"There needs to be a demand that you're trying to fulfill," says Imran Andrabi, MD, senior vice president and chief physician executive officer of Toledo, Ohio-based Mercy Health Partners and senior vice president of clinical innovation in the Office of Operations and System Effectiveness at Cincinnati-based Catholic Health Partners. "You must feel like the way we do business is not working or not sustainable — that something needs to be different." Recognizing a need for change, such as to reduce costs and improve quality, helps make hospitals more open to changing their mindset. "It's not necessarily fundamentally changing who you are, but maybe taking a few steps in a different direction to look at the same problem in a different way," Dr. Andrabi says.
Root cause
One of the key mindset changes necessary to break down silos is moving from a focus on immediate needs to a focus on key operational defects. Dr. Andrabi says that traditionally, the healthcare industry has focused on symptoms — such as overcrowding in an emergency department — instead of the root cause — such as inefficient processes in the ED. Overcrowding represents an urgent need: the hospital needs to better manage volume to ensure patient safety and maintain its market share. However, concentrating efforts on simply trying to see more patients faster ignores a possible upstream cause that may require an entire redesign of the ED process. Attacking the root cause of a problem is a more effective long-term solution than trying to eliminate the symptom and fosters coordination among silos. "If you get at one root cause, you may be able to get rid of a thousand symptoms," Dr. Andrabi says.
One of the reasons healthcare providers have historically been hesitant to address root causes is the conflict between urgent needs and important long-term deficiencies, according to Mr. Sawyer. He says that healthcare professionals resist going upstream to determine the root cause because they think leaving the immediate downstream work could result in fatal consequences. In the example above, the ED team may be concerned that taking the time to reassess their processes may put emergent patients in danger of not being seen, leading to potentially severe health outcomes. "It's a dilemma in the hospital system," Mr. Sawyer says.
One way hospitals can overcome this dilemma is to develop an infrastructure that allows providers to address root causes without sacrificing immediate patient needs. "Leaders can enhance the creation of an environment in which people can start taking their time away from urgent [tasks] and spend time thinking about the causal effects and important things in the organization," Dr. Andrabi says.
System aim
In addition to focusing on root causes, hospitals need to create a system aim to change mindsets towards breaking down silos. A system aim outlines the organization's primary goals and strategies on achieving those goals. Dr. Andrabi suggests hospital leaders "articulate that vision in such a way that people are willing to be part of it and can see what's in it for them — that they're not just doing it to make a change, but doing it to get a better outcome, better processes and a better environment in which people have the ability to do meaningful work."
Departments
Once hospitals begin to change their mindset, they need to work on fostering collaboration among departments to break down silos and improve patient flow. Efforts on improving patient flow need to involve the entire organization, because patients, staff and information travel between departments; they do not stay in separate silos. Optimizing flow in one department may not necessarily improve overall patient flow if the departments do not coordinate with each other. For example, Dr. Andrabi says a hospital lab reported having 96 percent of its labs on the charts by 8 a.m. In itself, this figure seems positive. However, looking beyond the department, Dr. Andrabi found that surgeons began rounding on their patients at 6:30 a.m. — making the lab's achievement less valuable.
"Hospital-wide coordination enables you to be in a situation where you are looking at the outcome and what needs to be done within the organization as a whole to be able to achieve that outcome," Dr. Andrabi says. Similar to shifting to root cause-thinking, moving from silos to coordinated departments marks a change from immediate needs to organization-wide needs. Considering the functions within the entire organization is key to making true improvements in patient flow.
One way Dr. Andrabi's team improved patient flow through department coordination was creating a partnership between the ED and critical care unit. When an ED patient was identified as potentially critical, a team of nurses from the intensive care unit would go to the ED to stabilize the patient there and then transport him or her to the ICU. This collaboration eliminated the step of ED nurses sending the patient to the ICU, which sped the process and improved patient outcomes.
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