Behavioral Treatment for the Fragmented Hospital

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Buddha says, “Where we have the most difficulty, we have the most to learn.”

Business organizations often use the term “silo”, when referring to employees or departments who work as autonomous units within an organization. Organizational silos can be a department with a vertical top-to-bottom hierarchy or horizontal across several departments. For example, a horizontal silo would be exclusive camaraderie between members of a C-suite at the top level of management, or across departments among the administrative assistants. The same applies in healthcare organizations.

Why do they exist?

Silos exist in most companies. They form for reasons that are rational and deliberate, such as giving employees with specialized functions the environments they need, or allocating resources effectively. Silos also emerge when members of an organization have common experiences, such as years of education in a particular field giving rise to a subculture of vocabulary and humor. Ask any non-clinical spouse about the behavior of their physician husband or wife at a cocktail party. When other physicians are present, the doctors have aggregated to “talk shop” within minutes! Other obvious factors that reinforce segregation are the placement of offices in the building, dress codes, schedule flexibility and pay-rates.

Although silos can be formed both consciously and subconsciously, they can fragment organizations by creating an ‘us and them’ culture, making employees restrict their responsibilities and state the all-too-familiar “it’s not my job.” Any mentality that breaks down connections and interferes with mature communication between people eventually leads to destructive differentiation which, sooner or later, creates problems for a business. There is no shortage of discussion on how silos within an organization create waste, resist change, and cause gaps in responsibility, all the factors that cause customer dissatisfaction and erode the financial bottom line.

Let’s switch it up with a behavioral therapy approach!

What can hospitals learn by turning the organizational hierarchies inside out and upside down for a day? One way to do this would be to schedule a day once a month when employees changed jobs, and walked in someone else’s shoes for a day. Maybe a housekeeping person would don a suit and lead meetings, while the hospital CFO would clean patient rooms (in less than 30 minutes each) or run the cafeteria cash register during busy times.

Usual position Job for
a day
Activity Problems Experienced Solutions
CEO Parking attendant Stamps tickets and collects money Hard concrete floors hurt back, everyone is in a bad mood Create better working conditions
House- keeping CFO Runs hospital finances and attend leadership meetings Lack of camaraderie, lack of exercise Less fear of management, willingness to speak up
Physician Patient Enter ER for injury that requires in-patient care Waste a day of time, privacy disrespected by rushed clinician, exposed to sick people in waiting room Streamline admission process, reward clinician focus on single task, create separations in waiting rooms.

This is when the magic could happen! Would there be great resistance and protests? The answer to this question is a resounding “Probably!”

However, much could be learned from this exercise. Unsung heroes, process inefficiencies, and financial discrepancies might be uncovered. Shaking up the silos, rather than just talking about them, could immediately highlight problems and suggest novel solutions.

What would the CEO learn if she had to be the hospital facility manager for a day? What would the physician learn if he were a patient with a severe injury? When a person is made to engage in different behaviors, they can gain new insights and better understand the frustrations and joys of a different role. This may in turn lead to greater appreciation for others’ roles and improved staff satisfaction and productivity.

What job would you like to try for a day? What job would you want to stay away from? And of course you see this coming…. WHY? Let us know in the comments below!


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