Organization Charts and the Silo Mentality

Silos also exist within the administrative, business, and financial side of healthcare. Work is divided by function (i.e., human resources, finance and accounting, supply chain, quality and

Hierarchical organization design

Figure 5.2 Hierarchical organization design.

performance improvement, information technology, etc.).

Organization structures further define the decision-making processes within the silos. Roles, responsibilities, and relationships, as well as the hierarchy or authority, are clarified by organization charts. Accompanied by position descriptions, position control, performance review, wage and salary, and other supporting systems and documentation, the organization chart explains how each position fits within the overall enterprise and defines

■ How positions are grouped and what people do

■ Who each employee reports to and the leader’s span of control

■ Who owns specific decisions, assets, or capabilities

A typical organization structure is illustrated in Figure 5-2.

Historically, the organization chart was a static document that did not change very much. During times of stability, there were a number of pros to the organization chart and the organizational silos it represented, including:

■ The workforce specialized in their specific functional subject matter expertise.

■ High performers followed a vertical career path and typically rose quickly within their silo.

■ Processes, information systems, and communications were optimized for the needs of the silo.

■ Decisions were made based on the functional experience or expertise of leadership.

The cons, however, become more apparent during times of transition or transformation. Today, organizational charts often are obsolete before they are published. While healthcare leaders have experimented with a variety of nontraditional organizational structure designs (i.e., matrix, dyads and triads, hub and spoke, etc.) in an attempt to eliminate some of the cons, the silo mentality is alive and well. A cultural phenomenon, the silo mentality is defined as “a mindset present when certain departments or sectors do not wish to share information with others in the same company. This type of mentality reduces efficiency in the overall operation, reduces morale, and may contribute to the demise of a productive company culture.”5 “Silos create an environment where sharing and collaborating for anything other than one silo’s special interests is virtually impossible,” says Vijay Govindarajan, the Earl C. Daum 1924 Professor of International Business at the Tuck School of Business at Dartmouth.6

The silo mentality is often compounded by decision-making approaches within and across many healthcare enterprises. Decisions are made in one of two ways, with

■ Someone with authority making a pronouncement or calling the shots, or

■ Everyone providing input in hopes of gaining consensus

Authority-driven decisions provide accountability and responsibility but are often problematic. In today’s world, many of healthcare’s most pressing issues require multiple perspectives to address effectively. Consensus, on the other hand, may sound appealing based on the desire to have everyone onboard. Yet, it is not always effective and often gives everyone veto-power. “We have a vote of 100 to 1, and we call it a tie,” exclaimed one healthcare executive. Additionally, consensus-based decision making can be frustrating in that decisions are slow, hard to reach, risk averse, and rely on groupthink.

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