Friday, 17 January 2014


Australia is a predominantly flat country. There is a mountain range running for about 800 k from south to north and a couple of hundred k inland from the south east coast. But that’s about it for elevation. West of that range are sweeping plains that go on forever.

On long drives across these plains one comes across silos from time to time. They are the only things with any height in the landscape and they sit as sentinels for the few inhabitants of the Australian outback. They are scattered and unconnected.

I had the same experience travelling by train from Vancouver to Edmonton. Once I cleared the Rockies the silos were all that interrupted the horizon. It must have been this that Denise Deveau had in mind when she wrote about the silos of Canada’s health care system in the September 17 edition of the Financial Post. Denise spoke of funding and systemic cultural silos and a lack of integrated technology; of multiple governance models and multiple jurisdictions all managing their own budgets; and different ministries all operating at their own pace. She described the silo mentality as systemic - from technology to treatment to the way healthcare professionals and providers are paid. Denise observed that the traditional forms of payment reinforce the silo mentality and encourage professional territoriality.

Such observations are not new and they are not unique to Canada.

ISQua’s Innovation and Systems Change Committee has been considering the limitations to this traditional approach to healthcare delivery and pondering alternatives to it.

The outcome of those ponderings is a paper commissioned by the Committee and prepared by Hilary Dunne entitled Capturing the Consequences of Adopting the Paradigm Shift of the Patient’s Journey.
Hilary found that the patient journey is typically regarded today as a paradigm that includes all aspects of the patient care journey from the time the patient notices symptoms of ill health to the point of better health or the need for palliative care.

The paper formed the basis of an interactive workshop at the Edinburgh conference at which the following questions were addressed:
  • How can we get innovation so that better models of care can emerge?
  • What emerging issues are likely to impact on the patient journey?
  • What does an improved model for the patient journey look like?

The ISQua innovations ‘brains trust’ has identified the following as some of the matters to be considered when reconceptualising the patient journey:
  • Digital health technology;
  • The patient as an expert on her/his own condition;
  • The availability of a ‘navigator’ to navigate the patient through the system and as a conduit for good practice;
  • The relationships of patient/provider and provider/provider;
  • The need for common definitions.

One suggested approach to achieving a seamless patient experience I came across in researching for this BLOG spoke of ‘building bridges to connect silos’.  For me this misses the point of rethinking how we move from episodic to continuous care. Simply connecting silos does not achieve the new paradigm.

In order to bring the best minds to bear on the need to rethink how we improve the patient experience from diagnosis to recovery or palliative care,  ISQua will host an invited seminar in 2015 on ‘2025’s vision of benefits and risks of changing healthcare – Reconsidering evaluation of healthcare systems in Western Countries through the prism of a system approach.

So, here is hoping that in 2030, after all this good work is done, I will not notice silos as I travel across the healthcare plains of the world.

Peter Carter
Chief Executive Officer
January 2014

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