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Management Silos are a regrettable fixture in far too many companies.  They are particularly egregious in health care where these ego-based fiefdoms drive up costs, frustrate employees and harm patients.

That far too many CEOs are reluctant to tear down these barriers is a sad reflection of how institutionalized these artificial divisions can be. What is depressing is that these silos are more about executive arrogance and ego, not improved efficiency, value innovation, or customer service and satisfaction.

There are two types of management silos.

1. The elephant in the living room variety.  Everyone can see it and smell it, even if they are reluctant to talk about it for fear of attracting attention and retribution by the guilty executives who control the silos.

2.  Passive/aggressive model.  This type of silo management is actually more dangerous for the organization because it is easier to ignore. The turf barriers are disguised until a well-meaning employee tries to make a change.  That is very common in healthcare organizations and that may be good reason why so many hospitals talk about improving quality of care and safety and far too few actually achieve meaningful results.  You cannot achieve improvements in quality and safety when executives are more interested in hoarding influence (read: silo control) than the common good of the organization and its customers.

Management silos are the structural equivalent of  the "shareholder first" business strategy, one of the dumbest ideas ever created, Jack Welch once said.  The MBA oath strikes a blow against placing the needs or greed of shareholders and corporate executives who make decisions solely on short-term factors that will drive the stock price against well being of customers, employees and the communities they serve.  If executives stay focused on those priorities, the argument goes, the shareholders will be well taken care of.

In healthcare, we need to tear down the walls, empower our employees and focus on the needs of our patients.  Early in my healthcare career, when I was flying around the country selling and implementing hospital-based helicopter ambulance programs, a wise old hospital CEO explained that if you take care of the needs of the patients and their physicians, you will be very successful.  "Ego and arrogance do not have a role in the show," he said.

That is a blinding flash of the obvious. However, for many leaders that answer must be wrong because it is just too simplistic.  Hospitals are among the most complex business organizations ever devised, Peter Drucker said. Truer words were never spoken.  But the complexity of the organization is not made less complex by silos.  It is only made worse.

Perhaps the simple answer is the right answer.

(c) 2010 John Gregory Self


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