How to eliminate the ‘Silo Effect’ in LTC organizations

The employees listened carefully to their boss as he outlined a new procedure.

“Any questions?”

None were raised, and the boss, pleased at the consensus, adjourned the meeting. But outside the conference room, the murmurs started.

How do they expect us to do that? Don’t they know that’s going to lead to this other problem? If they want that to happen, why didn’t they just do it this way? You and I both know that’ll never work, but I’m not going to be the one to say anything.

Me neither.

What is the Silo Effect?

The Silo Effect refers to a lack of information flowing between groups or parts of an organization. On a farm, silos prevent different grains from mixing. In an organization, the Silo Effect limits the interactions between members of different branches of the company, thus leading to reduced productivity.

Long-term care silos

Silos operate at various levels of long-term care. They can be found in the silent acquiescence of department head meetings, hospital transfers without complete documentation, care plan meetings where key players are missing, and nursing home admissions that neglect to provide residents and families with the information they need to become proactive members of the team.

In fact, our current healthcare system is one of silos: private insurers, Medicare, Medicaid, hospitals, nursing homes, home healthcare, regulators—all working independently, but connected, to haphazardly manage the nation’s healthcare.

Benefits of breaking down silos

Removing silos fosters innovation and increases productivity by unlocking the information needed for collaboration. For example, if the boss gets feedback that allows an easier way to carry out a new procedure, everybody involved in the implementation benefits.

If a coordinator assists residents in transferring to and from the hospital, this creates a bridge between the organizations that fosters improved care and reduces hospital readmissions. When residents and family members know what to expect from their admissions, staff time is freed from managing their concerns and is instead used for the right purpose: providing needed services.

How do I know if I’m in a silo?

Ask yourself these questions:

●  Are meetings (a) run top-down; or (b) do they include a free exchange of ideas and information?

●  Do facilities in multi-chain organizations (a) have wildly different corporate cultures; or (b) do they operate in a similar fashion, reflecting the core values of the organization?

●  Are there (a) communication challenges, such as difficult to reach team members or lack of an effective correspondence system; or (b) is it easy to relay information between facilities, departments and staff members?

●  Are customers—i.e., residents and families—(a) angry, anxious, and demanding; or (b) do they feel like a valued part of the team?

“A” answers indicate areas where your organization has silos. Use the techniques below to break free.

How to reduce the Silo Effect

Streamline procedures so that data is easily collected once rather than multiple times. For example, use technological tools such as smartphones to facilitate information gathering and to store it all in a central, accessible location. Set up an intranet to enhance communication throughout the organization.

Share best practices among facilities, departments and units. This can be done via an intranet “best practices” page, a newsletter or a contest that encourages creative and collaborative thinking to address company-wide problems, such as The Ensign Group’s e-prize competition to change “a day in the life of the resident.”

Encourage feedback and involvement in new approaches. In the opening example to this article, the boss could have broken through his silo by stating he was looking for more information, asking the question of specific employees (“Jane, you work with this all the time—what are your thoughts about implementing the new protocol?”), and presenting the process as a work-in-progress for the team rather than an order handed down from above.

Have a facility “suggestion box”—and take the suggestions seriously. A suggestion box allows people to anonymously share their ideas and experiences and can be a valuable source of information. Look beyond the complaints/suggestions for the underlying problems. For example, a request to change the curtains in Room 302 might reflect an environmental concern that needs facility-wide attention. Making a point of thanking the anonymous helper in a newsletter or other forum will encourage others to contribute to the operational health of the facility.

Listen to the resident and family councils. In this competitive atmosphere, the more satisfied the residents and families are, the more likely they’ll refer friends and neighbors to you. By raising concerns, they’re doing you the favor of pointing out areas that, when addressed, can become selling points for your facility.

Are you getting complaints about lack of Internet access for the residents? Fix that, and you’ve become a forerunner in the LTC field. Do the residents want access to the outdoors, even in the dead of winter? Set up a heated shelter that will become a highlight of your admissions tours. Are they dissatisfied with the approach of the staff? Train your team on customer service techniques and watch your organization flourish.

More information on silos

Deconstructing the Silo Effect can require significant thought and preparation. Consider these helpful articles as you approach this challenging, yet necessary, undertaking.

“Break Out of the Silo Mentality,” Jeffrey Cufaude, Associations Now, December 2009

“Tearing Down Business ‘Silos,’" Carol Kinsey Goman, The Sideroad

“Health insurers must abandon silo mentality to profit from ACO model,” Dina Overland, FierceHealthPayer, June 2011

Eleanor Feldman Barbera, PhD, is a speaker and consultant on psychological issues in long-term care, and author of the forthcoming book, The Savvy Resident's Guide: Everything You Wanted to Know About Your Nursing Home Stay, But Were Afraid to Ask. For more information, visit Dr. Barbera's website, www.mybetternursinghome.com.

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