Shake up hospital hierarchies to deliver better care

To provide the best possible healthcare, hospitals must shake up their rigid hierarchies, argues an opinion piece in Forbes.

The standard corporate "pyramid" model is wrong for healthcare, writes Forbes contributor Jeff Boss, because it turns the exchange of information into a game of telephone as the information descends the hierarchy. This means the lowest-level employees work with the least context, limiting their decision-making abilities.

"How this plays out in in a hospital today is that senior leaders talk about patient-centered care and increasing value but departments hear two opposing messages," he writes. "On the one hand there's a need to remove bottlenecks and increase throughput, or do more. On the other hand there's a need to reduce the length of stay and readmission rates, or do less."

This cuts to the heart of the matter, Boss writes: the structure of individual departments (or "silos") actively restricts the exchange of information. To deliver quality care, employees at the bottom of the pyramid should have access to the same information as those on the top. When everyone works with the same information, he writes, the entire pyramid understands the specific nature and purpose of what they and the rest of the employees do.

To that end, Boss calls for "turning the traditional pyramid on its head," allowing the larger group to share more information and making sure that information has been whittled down to its essence by the time it reaches the smaller end. Boss cites the example of the military's Joint Special Operations Command, which restructured from a hierarchical model to a network model, and went from executing 18 missions per month in 2002 to more than 300 per month in 2006.

These rigid structures must be overcome as the healthcare system moves toward team-based care, Gregory Sorensen, M.D., CEO of Siemens Healthcare North America, said at U.S. News & World Report's Hospital of Tomorrow conference last year. "There's a definite hierarchy, and those hierarchies get in the way," Sorensen said. "[But] people have learned that you can build a system that delivers consistent high quality if you can build teams."

To learn more:
- read the opinion piece