Breaking Down Clinical Silos in Healthcare

EACH OF THE feature articles in this issue of Frontiers of Health Services Management begins by addressing the many factors that have developed and are spurring significant changes to healthcare delivery in the United States. To those of us involved in the healthcare industry, these factors are not new. In some cases they were also at play in the early 1990s, when they contributed to both the advent of and the backlash to managed care. What makes this time dif- ferent is that, although unsustainable healthcare costs, decreasing reimburse- ments, and new payment structures mandated by the Affordable Care Act are realities, the changes to the healthcare delivery system are coming from within healthcare itself instead of from the health insurance industry.Both articles emphasize that integration of resources and coordination of care play crucial roles in reaching goals for enhancing community health and reducing the overall cost of care. Both articles also encourage healthcare providers to avail themselves of newer reimbursement models stemming from the Medicare Shared Savings Program, bundled payments, and, ultimately, global capitation. Although both articles discuss transformation, their perspec- tives differ: Leaver focuses on the structural realignment of a large multistate healthcare system, while Molden, Brown, and Griffith focus on a service line realignment within a healthcare system. Whether through disruptive innova- tion, as discussed by Molden, Brown, and Griffith, or through coordinated care, as described by Leaver, each system achieved a new type of service delivery that brought physicians and hospital resources together in a more coordinated way. Each article describes an approach to confronting the clinical silos of care, and each system appears to have made good strides in breaking down the clinical silos in its geographic area.WHY IS BREAKING DOWN SILOS SO DIFFICULT?As the articles illustrate, restructuring, whether of an entire healthcare system or of a service line, is not easy and requires commitment to a shared vision. That vision first needs to be created and then needs to be reinforced over and over until it becomes accepted and sustainable. Many times the initial conversations begin from a need for self-preservation and, as both feature articles note, subsequent progress requires hard discussions and real dedication to work- ing from common ground. Healthcare is composed of a host of special interest groups whose members have their own special- ized, academic preparation, social system, and approach to the work they do. The many differences can lead to widespread mistrust, which can be dispelled only by the passage of time and working together to build relationships. Eventually, broader understanding will help the groups to put new approaches into perspective and check their biases at the door when meetings are held. And ultimately, they will recognize that the issues at stake are more important than their differences and that collaboration will make their goals more attainable.I believe these articles reflect the laser- beam perspective that today's healthcare leaders and boards of directors have about how to organize, integrate, and align their organizations to be successful with fewer resources and how to genuinely improve healthcare quality and patient satisfaction. The changes described in these articles have massive structural and cultural ramifications, and their architects should be applauded for their foresight and their dedicated, consistent leadership in achieving their goals. Another area of focus, however, is equally important to the discussion of breaking down the silos we have in healthcare today, and it is far more granular and pervasive in our healthcare delivery system.WHERE IS PATIENT SAFETY IN THIS CONVERSATION?As both articles show, the organization of healthcare delivery is both specialized and complex. As new structures are formed, the delivery system expands to include them, whether as owned or as contracted resources. …