From diagnosis to discharge, surgical care involves multiple key teams. While these teams are fundamentally interdependent, they often function in relative isolation in practice. Each team focuses on its specific responsibilities before passing the baton to the next.
In this blog, we explore how this setup both reflects and reinforces the development of silos within surgical care. These silos can impact the quality and efficiency of perioperative care. We’ll also discuss some strategies to help break down barriers, enhance collaboration, and leverage our collective strengths to achieve the highest standards possible.
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Silos are more than just a business buzzword—they're a reality many organizations face. Often cited as a major issue, silos hinder effective communication and collaboration. Think of situations where surgical technicians don’t interact with sterile processing, or anesthesiologists don’t communicate with recovery staff. Over time, these behaviors prioritize the goals of individual teams over the organization as a whole, leading to inefficiencies and repeated patterns.
Gillian Tett, in her book *The Silo Effect*, describes silos as a form of systemic fragmentation, where departments operate independently, akin to "the right hand not knowing what the left is doing." She uses the example of large investment banks, where internal divisions function as competing tribes, each with distinct targets, jargon, incentives, and identities. Sound familiar?
Beyond organizational silos, individuals also form mental silos based on their backgrounds and cultures. This tunnel vision limits perspective and perpetuates similar mistakes. While silos exist for practical reasons, they can also hinder progress. As Tett notes, “The modern world needs silos,†but we must avoid letting them control us. By stepping outside our comfort zones, we can critically assess our processes and strive for improvement.
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> “The challenge is not to rid ourselves of silos but to master them, instead of allowing them to master us.â€
— Gillian Tett, *The Silo Effect*
In surgery, identifying silos is fairly straightforward due to the traditional, rigid organizational structures. Hospitals typically divide work based on stages of perioperative care and geographical locations, creating specialized teams. These divisions foster strong tribal identities and habitual behaviors.
The intraoperative phase, especially, presents a complex environment with multiple teams working simultaneously. This complexity increases the risk of errors, communication lapses, and information loss—all hallmarks of a silo mentality.
Poor communication between teams is perhaps the most notable feature of a silo. In fields like aviation, nuclear power, and healthcare, communication failures are widely recognized as leading causes of adverse events. Studies show that in the operating room, communication failures occur in 30% of team exchanges, with one-third affecting patient safety. Most of these failures happen between anesthesiologists and surgeons, two of the primary silos in the OR.
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Communication breakdowns don’t just harm patients; they also reduce operational efficiency. Researchers observed 67 communication failures in Chicago’s ORs during 150 hours of observation. Thirty-six percent involved equipment issues, and 24% stemmed from poor updates about the procedure’s progress, often causing delays.
A 2017 systematic review of process mapping tools highlighted inefficiencies in the OR, particularly at interfaces between teams, such as patient transfers and equipment setup.
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One solution lies in fostering a universal surgical language. Opening data silos has consistently improved outcomes. Initiatives like Integrated Care Pathways and Enhanced Recovery After Surgery have enhanced outcomes through shared resources and data. At Incision, we’ve developed a stepwise framework for standardizing surgical procedures, reducing errors and improving performance. Our online academy, Incision Academy, offers over 750 courses filmed live in the OR, accredited by the Royal College of Surgeons of England, with over 170,000 users worldwide.
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On the ground, mobile technology is revolutionizing team connectivity. Incision Assist, a mobile app, provides teams with unit-specific, team-specific, and surgeon-specific resources. It improves information flow, equipment familiarity, and cross-team processes like patient turnover.
Imagine this scenario: In the holding area, the pre-op team checks Assist to ensure everything is ready for anesthesia, including the video-guided system this anesthesiologist prefers. Meanwhile, the OR is prepared exactly as this surgeon likes it, with no confusion over equipment, all mapped out in the app. The surgery starts on time.
Midway through, recovery staff easily checks the surgical steps in the app to confirm drain placement. Post-op instructions in recovery are clear: no antibiotics, food after four hours, back to the ward, review tomorrow. Protocols are always updated, accessible, and just a click away.
By connecting our silos instead of trying to dismantle them, technology allows us to harness the combined strength of our teams. Here at Incision, we aim to spark conversations, bring teams closer, and educate dynamically. When we learn together, we grow stronger. Join the conversation!
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