As I prepared for my Saturday lunch with a friend, my partner who is a navigating officer on ships ranted about him having to study for his licensing exam (sound familiar already?).

He exhibited frustration over how the meteorological department sitting in the office decides how the ship must be navigated to achieve the best fuel efficiency. He said “If we go from where they tell us, we will save 5% fuel, but we will 100% get grounded*”. “Don’t they talk to the topographic safety person or the superintendent (an ex-navigating captain) whether their meteorological recommendations for the ship’s course are right? There must be SOMEBODY who knows both…”, I asked, and then it hit me. Silos!

Silos exist in every industry, and healthcare is not an exception. Field-office silos are by-far the most obvious. Just like the ship charterer has no clue about the nuances of navigation, the hospital management has no idea what goes into treating/curing a patient.

Management often sits in board rooms and has 4 MBA holders decide the budgeting of surgical departments, with minimal knowledge of how this budget is affecting patients, nurses and doctors. Don’t get me wrong, we see inter-departmental silos as well, where the medicine department won’t admit a patient that has a diabetic foot ulcer till the general surgeon takes care of it; we see it amongst surgical departments themselves where surgeons discuss whether a shcwannoma should be treated by the neurosurgeon or ENT surgeon (true incidents, among a sea of many others). The scariest silo perhaps, is that between the healthcare industry and patients.

While patient-engagement is gaining importance in the design of medical products and procedures, it is still seen as more of a “check-off” point in the to-do list, rather than an integral part of the design. Despite the many lessons in healthcare technology, where a product has failed due to its disconnect from the real patient journey (case in point: mobile applications for patients with chronic-illnesses, that rely on the inherent motivation and schedule adherence of a patient, which can be non-existent, considering all the other health-related activities that such patients already have to do), I am still met with disbelief when I recommend a patient-advisory board (PAB) in the MVP building of a health/medical-tech product. Through tools like PABs, we bridge the gap between the silos of patient-care and the patients themselves.

But are all silos bad? Not in the least! Work delegation in healthcare was started to reduce the burden of administrative work on care-givers, and because the need for specialized practitioners was very clear early on. Where we lost our way was thinking that adopting the structure of other industries in healthcare would lead to the same structure and results. If a ship is grounded, it leads to massive monetary losses, which, while not ideal, is incomparable to what the result of bad coordination in healthcare is: loss of human life, or lowered quality of life due to negative health outcomes. Thus, silos in healthcare need to be broken down, and broken down quickly. How should we go about it?

Do:

1. Knowledge exchange: Ignorance is often the reason for silos. If the management is not made aware of the processes in patient care, they will not make recommendations in line with it.
2. Partnerships: Collaborations between healthcare technology companies and physician associations is proof that with positive partnerships, we can get closer to a better product for the patient, which is indeed the ultimate goal.
3. Patient engagement: This not only means getting a PAB in the design phase or before an investory round, but also continuously in the usage.
4. Accountability: Each part of a process can only contribute positively if it is accountable for its contribution. In health-tech, tech makers are burdened with making changes for adoptability, but physicians may shrug off the responsibility with the argument of “over-burdening”. However, the same physician also complains about the non-physician-friendliness of the tech. You understand what I am getting to.
5. Be motivated by deep purpose: There is the concept of “concentric merger” in business, where two or more entities combine around a common user. Healthcare is about helping patients. Period. There is no purpose deeper than helping other live a better and healthier life. With alignment on this common primary goal, we may have secondary goals, but the focus on the former should be unwavering.

Don’t:

• Blame
• Condescend
• Create unnecessary barriers
• Be afraid to ask for help
• Stop learning

I am a believer of action statements, be it on a CV or in an article addressed to anyone and everyone in healthcare. I urge you, whatever be your role in this complex, yet simple, world of patient care, to see what silos you are in, understand its impact, and strategize to bring them down. I am always here to help.

*Grounding is exactly what it sounds like: when a ship’s bottom comes in contact with the sea floor or the ground.