Abandon Your Silo


Published: 18 August 2018

Farmers have successfully used silos of different shapes and sizes for centuries to store grain for animal feeding (Beedle 2001).

Although silos perform satisfactorily on farms, accidents and deaths can occur during the loading and unloading process.

What does this have to do with healthcare?

Regardless of our profession - nursing, medicine, pharmacy, respiratory therapy, physical therapy, etc. - most of us were educated in silos, and many of us continue to practice in them.

Take my profession, nursing, as an example. Originally, we were trained in hospital schools where we lived and worked in a controlled environment. We interacted with physicians, therapists and pharmacists, but our focus was on our nursing duties and responsibilities for our assigned patients.

We didn’t think about the responsibilities and roles of other professions. We worked together to provide patient care, but each profession functioned separately.

As nursing education moved from the hospital to the university setting, we attended a few classes with members of other professions, but that didn’t translate into interprofessional collaboration on the units/wards. Instead, we functioned as an interprofessional team with roles still narrowly defined for each profession.

Today, healthcare is evolving across the globe, and sitting on committees together is no longer enough for us to abandon our silos and achieve quality patient care with the patient at the centre of the team.

Patients and their support persons aren’t content to follow instructions and have care 'performed' for them. They are informed and want to be active members of the care team. This is a new development for professionals who are used to passivity and compliance.

Our old silos no longer work. It’s time to abandon them and use a revolutionary approach - interprofessional team care, with the patient at the centre of the team.

The Interprofessional Clinical Learning Environment

The interprofessional clinical learning environment is a truly collaborative approach to patient care where everyone involved in the patient’s care leaves their silo to listen and learn from each other, for the patient’s benefit.

Housekeepers and other support personnel often have knowledge about the patient’s needs and desires that nurses and physicians don’t. It does take a village to truly achieve patient goals and we must understand each other for improved outcomes (Disch et al. 2017).

Crowd of people at a conference session

Interprofessional collaboration is applicable to all healthcare environments. One example is the use of interprofessional education and work-based learning to promote collaborative practice in primary care in the United Kingdom.

A study conducted in 2012 reviewed literature about the effectiveness of interprofessional education in primary care. Work-based learning was addressed as a practical approach to providing interprofessional education. Use of work-based learning in primary care could provide an opportunity to create a 'community of practice' (Cameron et al. 2012).

In October 2017, the National Collaborative for Improving the Clinical Learning Environment (NCICLE) hosted a symposium for approximately 100 representatives of US healthcare professional organisations to explore an optimal interprofessional clinical learning environment. I was privileged to participate and, over two days, we rigorously debated current healthcare issues and reviewed the benefits of the interprofessional clinical learning environment.

Discussions evolved to describe how characteristics of the interprofessional clinical learning environment are seen at the unit/ward level, hospital/clinic level, and the health system level. It was an auspicious beginning, but it was only a beginning. The work continues and will for many years (Hawkins et al. 2018).

The report is available under the Creative Commons Attribution-Non-Commercial-ShareAlike 4.0 International License (ISBN: 978-1-945365-20-1) here.

Silos are positive for farmers - not for healthcare professionals or the patients they serve.

It’s time to abandon your silo and advance your profession as a member of an interprofessional collaborative team. Your patients will benefit and so will the entire team, including you!

  • Beedle, P L 2001, 'Silos: An Agricultural Success Story', in Giving Old Barns New Life, Madison: University of Wisconsin-Extension, viewed 15 August 2018, https://learningstore.uwex.edu/Assets/pdfs/G3660-04.pdf
  • Cameron, S, Rutherford, I & Mountain, K 2012, 'Debating the Use of Work-Based Learning and Interprofessional Education in Promoting Collaborative Practice in Primary Care: A Discussion Paper', Quality in Primary Care, vol. 20, no. 3, pp. 211-7, viewed 15 August 2018, https://www.ncbi.nlm.nih.gov/pubmed/22828676
  • Disch, J, Kilo, C M, Passiment, M, Wagner, R & Weiss, K B 2017, The Role of Clinical Learning Environments in Preparing New Clinicians to Engage in Patient Safety, National Collaborative for Improving the Clinical Learning Environment (NCICLE), Chicago, viewed 15 August 2018, http://www.abqaurp.org/Docs/NCICLE_Patient-Safety-2017.pdf
  • Hawkins, R, Silvester, J A, Passiment, M, Riordan, L & Weiss, K B 2018, Envisioning the Optimal Interprofessional Clinical Learning Environment: Initial Findings From an October 2017 NCICLE Symposium, National Collaborative for Improving the Clinical Learning Environment (NCICLE), Chicago, viewed 15 August 2018, https://ncicle.org/


Sue Johnson View profile
Sue Johnson, PhD, RN-BC, NE-BC has been a practising nurse for 50 years. She is currently Principal and Founder of RN Innovations LLC, an education management company, and has served in multiple roles during her career, including staff nurse, manager, nursing resource management specialist, educator, accreditation specialist, and director of clinical excellence and nursing research. She is the author of three books, numerous journal articles, and has contributed multiple chapters to clinical textbooks. She is currently a Commissioner for the American Nurses Credentialing Center’s Commission on Accreditation and frequently presents on interprofessional education/collaboration and quantifying nurses’ contribution to healthcare. She resides in Fort Wayne, Indiana, USA.