Health and Healthcare Systems

Silos in healthcare are bad for us. Here's the cure

Silos can be bad for our health

Silos can be bad for our health Image: Steve Buissinne / Pixabay

Laurence Sperling
Chair of the World Heart Federation group on the Roadmap for Cardiovascular Disease Prevention among People Living with Diabetes; Professor in Preventive Cardiology, Emory University School of Medicine
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  • Silos in healthcare are detrimental to patient outcomes and increase costs.
  • On World Diabetes Day, many diabetes patients are not aware they are at risk of cardiovascular disease.
  • To break down silos in healthcare, patient-partnered care, technology and human interaction are more critical than structural changes.

It is believed that 463 million people are now living with diabetes worldwide.

The long-term complications of this disease include kidney damage, nerve damage, blindness, Alzheimer’s disease, depression and cardiovascular disease (CVD) – the number-one killer worldwide. All of these complications are very important issues in their own right – and often require specialist treatment.

The challenge of silos in healthcare

This is where the challenge of silos within healthcare begins. Many diabetes patients are completely unaware that they are at a higher risk of CVD, partly because the lines of communication between specialists are limited and patients' needs are dealt with episodically rather than holistically and preventatively. More importantly, people living with diabetes are often not included when medical plans are formulated. The biggest silo of all is perhaps that we do not take a patient-partnered approach more often.

The ideal model for healthcare would place the patient at the centre, with specialists in each necessary specialism sharing information and working together, perhaps under the overall management of a general practitioner (GP) to achieve optimal health outcomes.

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Unfortunately, this very rarely happens. Instead, very often, different teams manage particular aspects of a patient’s health in isolation. There are a number of reasons why this might be: structural, economic, practical, technological and even human. Whatever the cause (or causes), silos in healthcare reduce cost efficiency, impact the quality of care and lead to the duplication of services (that is, they create waste).

One contributing problem is that many GPs and primary care teams (who would ideally be responsible for coordinating a patient’s medical care,) are already stretched. in the US, half of all doctors report symptoms of burnout such as depression, exhaustion, and a sense of failure, which reduces the quality of care even further. One study of more than 1,000 physicians suggests that 60% of doctors want more time with their patients, and yet schedules get tighter and appointments shorter as practices deal with the economic realities of primary healthcare.

With GPs being forced to refer people living with diseases to specialists without having the time to integrate and analyse all the results, functional silo syndrome is almost guaranteed to be endemic.

To exacerbate this challenge, the Harvard Business Review points out that people always tend to prioritise vertical relationships in their day-to-day job – that is, relationships with their boss, and direct reports. Yet the same article also suggests that companies with more horizontal collaboration achieve greater customer loyalty and higher margins. In healthcare, the same principles are true. It is in the horizontal communication space – expert to expert, department to department – that real gains in both patient outcomes and economic savings can be found.

One example from the US city of Boston – an effort to coordinate care for end-stage renal disorder (kidney failure) across all stakeholders (dialysis units, hospitals, primary care providers and others) – is saving “twice the amount that it costs to run the programme”. Patient outcomes have also significantly improved with an average of “five fewer hospital admissions per patient per year” among people in the high-risk category. The potential gains are there for all to see – as are the practical challenges. The real question is how do we break down silos in healthcare?

COVID-19 represents a huge opportunity for healthcare to hit reset and acknowledge where lessons can be learnt. That includes the impact we’ve seen at a corporate level. Some CEOs have demonstrated genuine leadership in protecting their workforce – often in the absence of leadership elsewhere. This mindset needs to remain a key part of the puzzle as we find ways to move from reactive to proactive healthcare.. Preventive healthcare needs to begin at home, at work and at school. We need an integrated approach to healthcare.

An integrated approach to healthcare
An integrated approach to healthcare Image: The author

An integrated approach to patient care

Within the health system itself, one of the most urgent actions to be taken is to improve access to patient data and medical information across all care teams. Technology is critical for this, which means tackling IT compatibility issues at a national or even regional level, and potentially legislating to ensure data is shared. The tools exist, so these must be put in place.

Virtual healthcare itself offers huge opportunities not only to provide patients with access to specialists they might not otherwise be able to reach, but also to manage each patient’s overall healthcare in a different way, ensuring that not just raw data but analysis and insight is shared across medical teams. And once the communications technology is in place, it is worth emphasising the human aspect.

In the corporate world, silos are broken down in very deliberate ways. Some of these methods could be used within healthcare. In aviation and heavy industry, incident teams take learnings from mistakes, and this can also be replicated in medicine. In Minnesota, one health system uses a technique called focused event analysis to bring different medical professionals together in the event of a failure – on the understanding that most failures have multiple causes. This can result in systemic improvements and improved insight across teams. This is good. But rather than waiting for a failure, near misses, or even hypothetical risks could be discussed in this way.

Focused event analysis is an example of cross-silo dialogue, which can take multiple forms. This is where different teams are brought together to learn from each other an interactive way. It is by working at these intersections that companies often innovate. Why would the same not be true in healthcare?

Perhaps a logical place to start would be common patient pathways. With people living with diabetes often requiring support from endocrinologists, cardiologists and neurologists, is this an opportunity for those teams to seek each other out for collaboration more frequently?

A framework for collective action in healthcare
A framework for collective action in healthcare Image: The author

Building cross-functional capabilities is another corporate approach that healthcare could learn from. Medical students tend to rotate to different positions during their training, but why not continue this practice throughout a doctor’s career? When healthcare systems are nationalised, giving doctors short periods working with specialists in other areas of medicine would help to break down cultural boundaries, provide networking opportunities within the healthcare system and allow doctors to absorb alternative perspectives.

Taking in other people’s perspectives is one reason why we at the World Heart Federation are running an online panel discussion on November 16 at 16:00 CET to understand silos in healthcare and learn how to break them down. If you have any thoughts on the topic and would like to participate, we would be delighted if you could join us.

A framework for collective action in healthcare

We need to take collective action to improve global health as well as healthcare in the future. We need an integrated and patient-partnered approach to caring for people living with diseases like diabetes. And we need to start breaking down silos at all levels to reap the economic and medical rewards this offers.

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Health and Healthcare SystemsStakeholder Capitalism
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