Breaking down professional silos: the potential of integrated management.

Articles in both business and healthcare literature make frequent reference to the need for integration in healthcare organizations. In healthcare, the term horizontal integration can refer to the purchase of one hospital by another in the same geographical area, particularly where the hospitals' services overlap. Services might be consolidated in this example or one hospital may totally shut down the acquired one. Vertical integration refers to a hospital exercising control of its inputs or outputs. In one sense, patients referred to a hospital can be considered inputs. A hospital that purchases physician practices or integrated delivery systems is an example. Purchasing a nursing facility by an integrated delivery system (IDS) is another. This article focuses on organizational or holographic integration, where an organization is understood and embedded--like a hologram--in each of its smaller components, and each operating unit has knowledge about the whole system in which it is embedded. Conceptually, a hospital can achieve organizational integration relatively easily. One way is to assign administrative responsibility for two departments, radiology and pathology, for example, to one person who will handle billing, budgeting and human resources issues. Organizational integration breaks down turf barriers between distinct functional areas (often known as stovepipes or the silo mentality) because the result is less energy expended to solve problems. Organizational integration must include the merging of information technology (IT) into a single computer system that can report results across several departments, for example, in order entry, result reporting, resource scheduling or billing. At the University of Michigan Health System, technical and organizational integration are taking place across the information systems of the radiology and pathology departments. Deployment of an intranet-based architecture for ancillary information systems will provide the means to achieve high level integration across previously heterogeneous and non-integrated department-based clinical information systems.