The Silos of Academic Medical Centers

A big challenge facing academic medical centers is how to maintain a focus on patient care in an artificially divided environment. Most academic medical centers were developed in a system with abundant resources, cost-based reimbursement and a traditional academic departmental structure. This led to individual departments growing as microsystems formed around particular specialties.

The untoward effect of this is that the different silos within the system tend to operate with their own success in mind, rather than the success of the enterprise as a whole. Department chairs strive to build their own empires and secure shared resources before other departments gobble them up.

So does this ultimately help or hinder an organization’s ability to deliver optimal patient care?

When individual silos seek to maximize benefits to suit their own needs, the entire system fails. This is a realty that is not unique to academic medical centers or medicine at all. In order to coordinate resources around what’s best for patient care, departmental leaders have to work in patient-centered teams. Does a breast cancer surgeon have more in common with the vascular surgeon down the hall, or the breast imagers and oncologists that are a part of their treatment team? Yet, the vast majority of academic medical centers still operate this way, out of convention.

Consider a situation where multiple department chairs are actively recruiting physicians who are all being promised operating room block time. The caveat is that there is not enough O.R. time to accommodate even half of the new positions. What about the impact of increased volume on surgical pathology? Are processes being put in place in advance to accommodate the increase in specimens? Are there enough anesthesiologists to cover the increased capacity in the O.R.s?

There are hundreds of consequences that come from a lack of strategy focused on patient care pathways – not to mention the impact on training residents and medical students. Will our academic medical centers be nimble enough to adapt in this rapidly changing world of healthcare?