Healthcare Does Not Have a Problem With Silos

Healthcare does not have a problem with silos.

In fact, there are no silos in healthcare; there are only boundaries.

If we truly want to change healthcare, we need to break boundaries.

The tired trope in healthcare is that we’re all in silos.  That each part of healthcare is isolated from the other.  If you go to any conference, someone will inevitably say that we need to tear down these silos and start working together – that research can work more with technology which can work more with doctors who can work with hospitals.  And that it is these silos that are holding us back from making a better healthcare system and stifling innovation.

People will say that patients are in silos.  They’ll say each disease community is siloed from each other.  Each of us with our own health issues are separated from people with other health issues.

But the truth is –

We are not in silos.

Silos store grains on farms.  They are generally tall cylindrical towers of steel or concrete with few openings and generally no windows.  Silos represent isolation – but it’s a forced isolation.  If something is in a silo, it was put there and it stays there.  Something in a silo has no view of what is beyond the silo.

Silos are passive.

Silos represent lack of autonomy.

Silos imply that we are incapable of seeing or interacting with anything beyond the silo.

Silos mean that we are in idly residing in a place we’ve been put.

We are not in silos.

We have created boundaries and we need to break these boundaries.

If we stick with the image of a farm, I’d argue that we’ve built basically fences, or boundaries, that hold us in.  It’s not that the breast cancer community cannot see the diabetes community NS doesn’t know they exist.  It’s not that research can’t see health technology.  It’s that people CHOOSE not to interact with each other.  We choose not to go beyond the fences we’ve built around our communities, the boundaries that hold us in.  It’s not that we are stuck in a silo that we’re unable to break out of.  It’s that we CHOOSE not to go beyond where we are.  We graze and cultivate within these artificial boundaries we’ve created and we perpetuate our inability to go beyond these boundaries by saying we’re stuck in silos.

Why do we stay within these boundaries?  Out of fear?  Do our boundaries make us feel safer because within them we feel like we know something.  Do we feel we only have anything to offer to those around us, that we couldn’t add to another community? If we stray outside of what we know, what might happen?

I see this all the time.  The best example is hackathons.  Time and again I encourage everyone to go to a hackathon.  And time and again I will hear – “but I don’t know anything about computers.”  And I reply, “so what? You have more to offer than you think you do.  And you will learn more than you think you might – things that will impact your life in ways you wouldn’t expect.”

Simple example: In 2012, I went to a hackathon for Sphero (makers of BB-8).  They wanted people to make new games for them, generate new ideas.  It sounded fun, so I went.  Did I know anything about coding? No.  Did I know anything about Sphero? Nope.  Did I have any ideas for any games to make? Not a one.  But I went anyway because I wanted to break some boundaries.

I spent the time around the guys making games watching how their minds thought up ideas to play with this electric sphere that you could control with your phone via bluetooth.  At the time I didn’t even have a phone that could download the app to play with it.  And I thought, what if I made an obstacle course for it?  So I got the sugar packets and rearranged the chairs and some soda bottles and used someone’s phone to make an obstacle course.  Sure it seemed a bit lame, but if you look at Sphero’s website now, they sell a ramp and in the app store are games to do obstacle courses (see 0:14 seconds in). I’d like to believe it was at least in part because of me (probably not but I’ll hold onto the idea.

I did have something to offer because I broke my boundaries.  And I learned from simply being there – about coding languages and project management for developing these ideas and a fun new toy that I still think would be really useful in the healthcare field.  I learned things that would later impact how I approach health technology – including coding EHRs – and thought about gamification in healthcare. Plus it was fun.

I don’t get to go to hackathons as often now, but if you ever get the opportunity, you should.  In the meantime, there are a million ways to break boundaries every day if we choose to.

Take part in a tweetchat outside your disease community.  This week I spent a little time in #bcsm (breast cancer social media) tweetchat.  I don’t have breast cancer, but I had something to add and something to learn.

Interact with someone in healthcare you’ve never talked to before.  Doctors need to start talking to patients but also to app developers and students in journalism.  Healthcare “influencers” need to talk to the people who are not “influencers.”  Conferences need to invite the homeless person in the park to their event.  Researchers can learn from someone working on a startup.  Computer science majors need to talk to non-profits.  Patients need to talk to venture capitalists.  Policy makers need to talk to the person bringing the food to a patient in a hospital.  It may seem like you have nothing in common but I assure you that you will learn from each other and you will have an impact on the other.  From my experience running Austin’s largest health tech group, I’ve seen what happens when people are brought together.  I promise you it’s amazing.

The challenge is, will you?  Will you choose to venture outside your “comfort zone”?  Will you stop building fences and take the chance to hop over them and see what’s beyond?

Healthcare does not have a problem with silos.  The problem in healthcare is boundaries – the boundaries that we create & maintain and within which we choose to remain.  We are not passively imprisoned in a concrete building.  We can see each other and we can take action to do something different – to break boundaries.

And what if we do break boundaries? What will we learn?  What will we see and experience?  What connections will be made? What innovation might result?

I’m fairly certain if we stopped saying we were in silos and we started focusing on breaking boundaries, we could change healthcare.

In fact, we could change the world.


Footnote:  It may seem that changing from silos to boundaries is insignificant.  But As every patient will tell you, words matter.

PS – See the bigger picture.


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