Thinking beyond the silo is a WINning proposition

Commentary. By Leonard J. Marcus, PhD, and Barry C. Dorn, MD, AMNews contributors. Dec. 23/30, 2002.

COMMENTARY

Observations on the state of medical practice and medical life

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There is a tendency in medicine to think in "silo" terms. The silo mentality refers to a perspective that is insular, parochial, and tilting toward the closed minded. Silo thinkers tend to perceive their work and activities in isolation of that of others.

If a group of silo engineers was instructed to build a car, each engineer would go off separately to design the motor, air conditioner, frame and interior. While they may end up with a smooth engine, a quick air conditioner, a sturdy frame and a slick interior, it would be no surprise that the combined product of their work would not function well as a "car" once on the road. In medical terms, this "whole-car" concept could refer to patient care, medical management or health system design.

The predominance of this silo thinking is understandable. In professional terms, training and career development occur in silos. Knowledge tends to organize itself in silo journals, with each of us concentrating on what is new and relevant in our specialty. Organizationally, our budgets, space and departments are bunched and distinguished into silos for ease and efficiency of management. We do business in silo arrangements. And personally, we tend to socialize and feel comfortable with others whose experiences, orientation, culture and knowledge are similar to our own.

Our silos offer us a reinforcing zone of familiarity that relieves self-doubt and encourages silo-reinforcing pursuits. It is as if our medical departments serve as compact villages in the vast expanses of space and knowledge that are health care. [...]