Working with a silo mentality can be detrimental to the delivery of high-quality patient care. At the 2017 Academy of Oncology Nurse & Patient Navigators (AONN+) West Coast Regional Meeting, Lillie D. Shockney, RN, BS, MAS, ONN-CG, discussed the warning signs and pitfalls of operating in silos, as well as how to avoid falling into them.
According to Ms Shockney, Program Director and Cofounder of AONN+, Administrative Director at the Johns Hopkins Breast Center, and self-described “farm girl,” a silo mentality is an inward-looking mindset that commonly occurs in healthcare organizations. Individuals operating in this manner resist sharing information and resources with other people or departments within the organization and conclude that it is not their responsibility to coordinate their activities with peers or other groups. “It occurs when people have little interest in understanding their part in the success of the organization as a whole,” she said.
Working in silos encourages localized, disconnected decision-making and a culture in which individuals blame others and do not take ownership for their actions, leading to apathy within a team and an increased workload for managers. “Managers struggle to engage people in collaborating to implement vital changes and complain that it can be like pulling teeth to encourage ownership of collective goals,” Ms Shockney said. “They expend significant time firefighting, which leaves little time to address the real causes of problems.”
Yet despite the inefficient arrangement in a silo system, change is often resisted. People are prepared to continually attend meetings and make the appropriate comments, but often do little until the next meeting, she noted, underlining the importance of designating assignments at the close of a meeting and checking back on progress. “And for managers, participating is just as important as delegating,” she added.
Silos operate at various levels of long-term care. They can be found in hospital transfers lacking complete documentation, care plan meetings missing key players, and admissions processes in which patients and families are not provided with the information they need to become proactive members of the team. When morale drops, people become “unthinking robots just trying to get through the day,” she said. But building a culture of trust can combat this effect.
Eliminating the Silo Effect
In the literal sense, silos prevent different grains from mixing. “They come in all shapes and sizes. Don’t assume you know what’s in someone else’s silo,” she said. “But the one thing everyone should have in common is the patient.” Differences in perception can cause confusion, but avoiding a silo mentality involves asking questions rather than making assumptions.
According to Ms Shockney, “silos haphazardly manage the nation’s healthcare,” and exist even in the field of navigation. There is unclear delineation of responsibilities among clinical oncology nurses, nurse navigators, patient navigators, social workers, schedulers, and office management. “We owe it to the patient to sit down as a team and understand who’s responsible for what and how we can decide on shared goals centered around the patient experience,” she said. “We should try to deliver that experience efficiently and effectively, with good clinical outcomes.”
Breaking down silos can be threatening but eventually fosters innovation and leads to increased productivity, as it unlocks the information needed for successful collaboration.
Are You Working in a Silo System?
Ms Shockney offered insight into identifying silos at work. In a silo system, meetings are run top-down rather than allowing for and encouraging the free exchange of ideas and information. Silos promote challenges to communication in the form of ineffective correspondence systems and difficult-to-reach team members rather than the easy exchange of information between facilities, departments, and staff. In silo systems, patients and their families are angry, anxious, and demanding, but breaking down the silo system allows patients and families to feel like important members of the healthcare team.
She suggests streamlining procedures so that data are easily collected once rather than multiple times; sharing best practices among facilities, departments, and units; and encouraging feedback and involvement in new approaches. “Sharing best practices provides comfort,” she said.
Ms Shockney gave the example of a patient being asked 3 times, on the day of her surgery, which breast will be operated on. “She’ll think we’re all in our silos, not communicating with each other, and we don’t know which breast will be operated on,” she said. “All these assumptions and perceptions can result in distrust. The patient needs to be warned that she’s going to be asked that question by 3 different people, so she understands it’s a matter of quality control and can trust that we’re doing the right thing.”
Provide a suggestion box, and take suggestions seriously, she said. Listen to patients and their family members, and decide how progress will be measured. If the baseline is unknown, change cannot be effectively measured. “It doesn’t matter the size of the institution; there will always be onco-politics to be navigated,” she said. “But most importantly, always keep your focus on the patient.”