Breaking down healthcare silos – and replacing them with something better


Providers are beginning to embrace the concept of holism when it comes to health care management.

When we hear the word “silo”, we tend to think of certain structures on farms. Basically, the function of silos fulfills the need to preserve grain for later use. In the simplest sense, they are designed to protect grain from rodents, insects, moisture, fire, or natural or man-made calamities such as floods, earthquakes, or wars.

While agricultural silos refer to the separation and storage of assets vital to a farm operation, organizational silos refer to the separation of another type of asset, vital to an organization: people. Organizational silos, in business terms, are defined as the separation of different types of employees, often defined by the department in which they work.

The silo concept is not new, as it has been ingrained (no pun intended) in our society. For example, high school: at the start, it is the same teacher for all subjects, a class, the homework of this teacher, etc. In the upper classes, there is a different classroom, and homework and teachers for each subject, with little or no communication between them: real silos.

We have these silos in healthcare, especially in the clinical revenue cycle (CRC). Luckily, we have a common factor for our siled existence that isn’t necessarily found in other environments – and that’s documentation. Each CRC module focuses on the same material, but through its own lens – and there is rarely knowledge sharing, partly due to disparate systems.

Ideally, for best functionality, these silos should be broken down, but should also be rebuilt, using a holistic point of view. Holism! What is that? Essentially, holism is a theory that no part is more important than another – or more important than the sum of all the parts, the whole. The human body is the most elegant example of holism. The human body is made up of many different silos or systems, but no one system is the most important. Arguably the heart or the brain is more important, but neither can function alone (or not be present at all).

In the clinical revenue cycle, to repeat, these silos need to be broken down, but they can’t be left that way. They must be rebuilt to:

  • Transversality;
  • Knowledge sharing;
  • interoperability;
  • Standardization; and
  • Responsibility.

Can you imagine if the brain didn’t share with the heart that it’s really hot outside, and the heart rate has to increase and the blood vessels expand to initiate sweating, in order to avoid overheating? Consider that knowledge sharing is only one aspect of the holistic approach. Just imagine the improvement and efficiency that could be achieved if we instituted a holistic approach to our silos.

We already have the key element – the documentation.

Note on the program: Listen to Dr. Zelem as he reports this story live today on Talk Ten Tuesdays at 10 a.m. EST.


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