Great at Work: The Hidden Habits of Top Performers

by Morten T. Hansen

These caregivers committed what we might call the First Sin of Collaboration: undercollaboration. The health system in Fort Dodge wasn’t designed to help people coordinate decision making and share information. Like most hospital systems in the United States, Fort Dodge Hospital was composed of departments that were separated by tall walls—what many call a siloed organization. This phenomenon of siloed care has expanded in recent years. Specialization has exploded: The American Board of Medical Specialties listed 65 specialties in 1985, 124 in 2000, and 136 in 2017.2 Meanwhile, the fragmentation of care has led to serious problems. A large study of 10,740 patient admissions across nine hospitals in the United States found that poor communication in handoffs from one provider to another resulted in many medical errors. When staff learned to use a simple communication tool, injuries from those errors decreased by 30 percent.3 When people fail to communicate across silos, bad things happen.