Written by Sabrina Rodak for Becker's Hospital Review
on March 12, 2012
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.
The online article can be viewed
here.