Process-orientated structures to overcome silo thinking: approaches for more effective collaboration in the healthcare sector

A semi-structured literature search was conducted to analyse current studies on silo thinking and organisational structures in the healthcare sector. Relevant scientific databases such as PubMed and Google Scholar were used for this purpose. Studies from 2000 onwards that relate to Western healthcare systems and offer practical recommendations were included. The selected studies were analysed thematically.

The following keywords were used and combined with Boolean operators: traditional structure, silo, process-oriented, collaboration, integration, barriers, change, teamwork, healthcare.

Hospitals today are usually organised according to specialist disciplines such as surgery, internal medicine or radiology. However, this structure is at odds with the complex patient pathways, which are often interdisciplinary. This results in communication problems, inefficiencies and quality deficiencies, which lead to delays and poorer patient care (De Ramón Fernández et al., 2020; Deneckere et al., 2013).

A review of the literature reveals the strong impact of organisational design on silo thinking. Fortunately, several studies also show concrete ways in which this silo mentality can be overcome through targeted organisational measures. For example, Bento et al. (2020) emphasise that focusing on common goals promotes collaboration between departments and supports patient-oriented success. Another important step is the removal of structural and organisational barriers. For example, according to de Waal et al, (2019), physical proximity and interdisciplinary meetings help to close communication gaps and strengthen collaboration.

Process-oriented organisational models show considerable potential to effectively break through silo thinking. These models promote the horizontal networking of departments and the introduction of clear, process-based structures that are orientated towards patient pathways. A process-orientated model focuses on designing workflows along the entire patient journey (see Figure 1). This breaks down traditional departmental boundaries and enables consistent, interdisciplinary collaboration. This not only improves co-operation between departments, but also increases the efficiency of patient care (Vera & Kuntz, 2007).

Additional organisational measures can be taken to further strengthen the positive effects of such models. These include, for example, the establishment of overarching teams and centralised offices that promote cooperation between the specialist departments. Adapted incentive systems could also be used to support cross-team cooperation and alignment towards common goals (de Waal et al., 2019). In addition, studies such as that by Goodell et al. (2009) show that the implementation of case management not only increases efficiency, but can also reduce the error rate. Case managers act as central interfaces that improve the flow of information between specialist disciplines and thus contribute to the optimisation of care. In the next section, specific case studies will illustrate the use of such measures in practice.

As we have seen, the implementation of measures to overcome silo thinking shows great potential, but is confronted with various obstacles. Resistance to change, both at an individual and organisational level, often makes it difficult to accept new processes (Inversini, 2005). In addition, insufficient resources, such as limited time, financial resources and incompatible IT systems, represent a barrier to the necessary networking and efficient exchange of information. A lack of clear responsibilities and inadequate change management can also jeopardise the sustainability of implementation (Reimer, 2009).

In view of these obstacles, it is clear that the healthcare sector needs to break new ground. Isolated working methods must be replaced by networked, co-operative processes in order to meet the requirements. Process-oriented organisational models offer an approach to breaking down silo thinking and improving cooperation between departments. By forming interdisciplinary teams and focusing on common goals, care can be created that is more efficient, more patient-centred and of higher quality and therefore better meets modern requirements.

Best Practices

The following two best practices show how successful implementations of process-oriented approaches and other integrative models can overcome silo thinking in healthcare:

1. Virginia Mason Franciscan Health (VMFH)

The care network implements targeted measures to address silo thinking and improve collaboration in the healthcare system. A central approach is the Rapid Process Improvement Workshops (RPIWs), in which team leaders and employees from different areas come together to jointly develop solutions for better communication and collaboration (Stewart, 2023).

In addition, VMFH uses visual management boards to make the exchange of information within the teams more transparent and the workflow more efficient. Standardised daily huddles allow important information to be shared quickly and strengthen teamwork (Stewart, 2023).

2 Brigham and Women's Hospital (BWH)

The hospital implements a coordinated end-stage renal disease (ESRD) programme that strengthens collaboration between dialysis centres, hospitals and primary care teams to improve care for people with kidney failure. Care coordinators identify people at increased risk, conduct follow-up consultations and coordinate treatments to reduce emergency visits and hospitalisations. Close networking and the exchange of health data promote more efficient and patient-centred care (Kelly et al., 2019).

Recommendations for action

A radical reorganisation of the organisational structure of a healthcare facility will rarely be possible. For this reason, the following seven smaller recommendations for action, derived from the scientific literature, can be helpful in practice.

• Define common goals: Align departments around common, patient-centred goals to strengthen collaboration and overcome isolated working (Bento et al., 2020).
• Promote technological networking: Compatible IT systems and shared electronic health records facilitate data sharing and increase patient safety (Deneckere et al., 2013).
• Improve communication structures: Visual management boards and huddles optimise information sharing and increase transparency within teams (Stewart, 2023).
• Establish interdisciplinary teams: Interdisciplinary teams from different specialities work together on patient-centred goals to promote collaboration and improve care (Vera & Kuntz, 2007).
• Introduce coordinating roles and case management: Care coordinators and case managers act as key interfaces, improving communication between specialities and promoting the integration of treatment information to avoid errors (Berry-Millett & Bodenheimer, 2009).
• Process optimisation through workshops: Process optimisation workshops bring together professionals from different areas to jointly develop efficient workflows and break down silo thinking(Stewart, 2023).
• Actively pursue change management: Targeted change management with clear responsibilities and training reduces resistance and promotes acceptance of new ways of working (Reimer, 2009).