Save the Silos!

Improving Patient Experience with Collective Impact


“Everyone talks about ‘breaking down silos’ in an organization. But silos were designed for a reason: to protect the contents so that they can serve their intended purpose. Rather than breaking them down, which would lead to chaos and loss, we need to focus on building better bridges between them.”

This insight from a Patient Experience leader speaks to the value of a concept called Collective Impact: the commitment of a group of important actors from different sectors to a common agenda for solving a specific problem. This seminal article by John Kania and Mark Kramer, published in 2011 in the Stanford Social Innovation Review, makes the point that large-scale social change requires broad cross-sector coordination. But while solving wicked problems is the goal of the article, the recommendations they make describe the process that any organization must undertake to find the root causes of the challenges they face.

The five elements of successful collective action include:

  1. Common agenda: all participants share a vision for change, including a common understanding of the problem and a joint approach to solving it through agreed upon actions. 
  2. Shared measurement systems: agreement on the ways success will be measured and reported.
  3. Mutually reinforcing activities: coordinating differentiated tactics through a strategic and phased plan of action.
  4. Continuous communication: using a common vocabulary, communicate progress toward goals to all participants at defined points in the process
  5. Backbone support: a dedicated staff that can plan, manage, and support the initiative through ongoing facilitation, technology, administrative and communications support.

Healthcare experiences are siloed by design. But to a lay person, who may not understand when thresholds are being crossed, it’s critical to point out when this may impact their experience. For example, a person having a routine colonoscopy at an outpatient surgery center may receive several bills: their primary care provider, a facility fee, the surgeon’s charge, anesthesiologist, pathology, lab services. And everyone knows that unexpected bills are never welcomed. 

It all comes down to this: in order to improve experiences, what do people need to know, and when?

Collective Impact creates an environment where bridges between silos can be built, with the goal of improving the understanding, and ultimately the experience, of the patient or family member. With respect to the “wicked problem” of patient experience, we’ve mapped out each element with a few thought starters. 

Common agenda:

  • Is patient experience designed for patients, or caregivers who deliver the experience? If the answer is “both,” how do we effectively address each?
  • How do people “get lost” in our system: Billing conflicts? Our patient portal? Pre- or post-operative instructions? The parking garage?
  • If the answer is “all of the above,” how do we tie these together for consistency?

Shared measurement systems:

  • Which metrics are most important to measure, and by what means? Certainly patient satisfaction scores, but what about staff engagement, staff retention, profit-sharing bonuses?
  • What are the true levers in our culture that motivate staff to make the most of every interaction?

Mutually reinforcing activities:

  • There is an ecosystem that supports each patient experience. How can we prototype potential solutions, test them with staff and patients, and iterate so we can be sure of a return on our investment?
  • One example might be a focus on a specific service line, testing messaging and interactions across media: is what the admin says on the phone the same as what’s stated in the pre-appointment letter? Does this match instructions in the patient information brochure and on wayfinding signage?

Continuous communication:

  • What’s important to communicate, and how often? Are there different messages being sent to different audiences, e.g. a monthly newsletter to cardiac patients vs. manager meetings for cardiac staff?
  • How do we design a system that clearly defines PX goals and progress to each audience? Most importantly, how does that progress benefit both staff and patients?

Backbone support:

  • How do we assure that these initiatives don’t “die on the vine”?
  • Who might we engage to develop and oversee a strategy that includes establishing an internal group of PX Champions, targeted goals, measurable outcomes, consistent reporting and ongoing assessment of PX initiatives?

In order to build bridges between silos and achieve tangible progress toward goals, organizations need to start having different conversations and using different “muscles.”

This requires thoughtful, intentional design. As you craft your organization’s experience strategy, consider assembling a diverse, cross-disciplinary team that’s tasked with seeing the big picture as well as getting specific about iterative progress toward goals. 

By increasing connections between silos, you’ll unlock the value inherent in each part of the organization, and see that the whole is greater than the sum of its parts.