Breaking Down Silos

Is this still a hospital supply chain challenge?

(Breaking down silos) of constituent politics – the bringing together of the various stakeholder groups – and guiding them toward a common mission,” as stated by Michael J. Dowling, Harvard School of Public Health, is still a big challenge for hospital, system and IDN supply chain executives. This situation has gotten significantly better over the last few years, but not good enough for the healthcare challenges we face now and in the future.

Too often supply chain executives shy away from these conflicts and misalignments, but handling constituent politics is the key to your success in the new healthcare economy. As we move from the notion that it’s OK for some clinicians, surgeons, and department heads that are politically connected to buy almost anything they want, to an era when all constituents must be accountable for what they buy, these silos must be broken down.

If your senior management won’t support you in these “breaking down silos” efforts, then you must take on this challenge yourself or risk becoming irrelevant. One way I have found to be very effective in doing this was to build personal relationships with these politically connected constituents by getting on committees (e.g, infection control, surgical, capital, etc.) that they chaired or on which they were members. This way I could interact with them as a peer and then relate to them as individuals. These interactions enabled me to get them to answer my phone calls or schedule appointments to discuss burning issues.

The second way I was able to break down silos was to appoint these individuals to value analysis teams, where they had to value justify their purchases to their peers. I remember one IT director who tried to stand his ground on a questionable software purchase, and who had to give in to the majority rule when he couldn’t figure out a reason why he shouldn’t bid this purchase. There is nothing like peer pressure to break down silos.

Lastly, another way I found that works to smooth the road is to appoint these individuals as team leaders on value analysis teams. One time we did this with a director of surgery who wasn’t keen on our PPI initiative, and who turned out to be one of the biggest supporters of our value analysis program. Why? Because he called the shots and was in control of his destiny!

What I just talked about is a reality at every healthcare organization in the country. Every hospital, system and IDN has their silos that are holding back progress because these constituencies believe they have all of the answers. Our job as supply chain executives is to break down and chip away at these silos until they are permanently removed.

If your senior management won’t help remove these obstacles to your success, don’t believe for a moment that this same management still won’t hold you accountable for the cost and quality issues that are being blocked by these politically connected individuals. Be proactive vs. reactive to avoid this unpleasant “Catch 22” scenario that could be coming your way!

About the Author

Robert T. Yokl
Robert T. Yokl is president and chief value strategist of Strategic Value Analysis® In Healthcare, which is the acknowledged healthcare authority in value analysis and utilization management. Yokl has nearly 38 years of experience as a healthcare materials manager and supply chain consultant, and also is the co-creator of the new Utilizer® Dashboard that moves beyond price for even deeper and broader utilization savings. For more information, visit For questions or comments, e-mail Yokl at