Silos, Tunnels and Lanes: Navigating Healthcare Culture
According to a recent research report from the Beryl Institute, The State of Patient Experience in American Hospitals, most focus on the patient experience is coming from leadership initiatives, but culture change is still a challenge. Although a common strategy is to form cross-departmental committees to address the issue, the biggest obstacle is that hospitals are still organized in departments. The success or failure of employees in each department is measured in metrics developed specifically for that department and often may be at cross purposes with the metrics for other departments whose work intersects.
As architects, we fall prey to the same thinking: we approach the design of each department rather myopically, when perhaps we should challenge the need to even have a department at all. Taking away the silo does not in itself produce change unless you also understand the tendency for "tunnels," what I call unrecognized links/connections that might be reinforcing the old culture and practices, are also identified. We need to envision the hospital as more of a highway dedicated to the flow of patients with various cars pulling alongside them to deliver needed services. Thinking in terms of lanes instead of tunnels and silos enables us to envision greater permeability and fluidity in design:
Destinations instead of locations
Certainly there are some functions that work best when patients are grouped in a single location (surgery, ED) But there are many others that, if we abandon our old ways of thinking, really are decentralized and coming to the patient (respiratory therapy, lab, some imaging). So, is there really a benefit to having a department called "Lab" when we could instead consider staff dedicated to bedside care or certain specialty procedures such as anatomical pathology as part of the departments where they work? This can be supported spatially by providing satellite areas within or between major departments as well as collaborative work areas to allow staff to feel they are part of the total care team.
Decentralization of equipment, services and staff
Perhaps core processes should be evaluated in terms of how they enhance each department they touch instead of stand-alone entities. A therapist or transporter who is part of the "ED team" is a lot more invested in the overall workings of the department and understands better how their part in the care of a patient affects the healing experience than does one who is simply paged as needed. The same is true for physicians, who need to view themselves as part of an overall care team that includes everyone from clinicians to administrative and support staff.
Multitasking and all purpose environments
Thoughtfully designed multi-functional, easily adaptable types of spaces with plenty of rooms for group interaction of the care team both with each other and with patients and families provided in key departments can go a long way in supporting the kind of culture change necessary to provide truly patient-centered care.
Shattering silos and eliminating tunnels means creating relationships among departments (or satellite departments) that mirror the flow of a patient through the space. All the other relationships and barriers that have evolved over time have contributed to a rigid us vs. them culture where everyone feels beleaguered. A more permeable lane-based concept allows the attention to really be where it belongs- delivery of care.