Breaking Down Silos: Getting It Done Chapter 10


Greater government intervention in healthcare delivery and patients’ demands for lower costs and improved quality of care necessitate greater collaboration not only within an organization but also between organizations: specialists have to work more closely with general practitioners; hospitals have to work more closely with physicians; insurance companies have to work more closely with providers.

Case Presentation

The Monroe Clinic consists of 700 physicians in 50 specialties and operates in 60 rural areas. The Monroe Clinic has no hospital facilities.

The Haddon Healthcare Group operates 15 hospitals in the region. Haddon also employs a large physician staff. The two organizations feuded with one another for decades, though no one knew the reason for this conflict.

Both organizations recognized the potential to improve their healthcare through a more synergistic relationship, but they did not know how to make that relationship happen. Merger was not an option because antitrust regulations prohibited them from joining forces and because powerful silos in their strong independent cultures would have made them incompatible.

As part of the leadership development exercise, Ralph Jacobson, President of the Leader’s Toolbox and chapter author, examined Monroe’s relationship with  Haddon  and determined that it was not a problem to be solved but a paradox to be balanced, in that the organizations had to compete and cooperate with each other. The paradox concept opened a new pathway for a healthier business and practice relationship.

Twenty-five leaders of the Monroe group participated in scenario-building exercises to:

  • develop a deeper understanding of what the organizations could accomplish if they had a stronger relationship
  • identify the potential risks and rewards of greater cooperation
  • define the current competitive landscape and project what it could look like in the future, and consider what might happen if they maintained the status quo

By the conclusion of the exercise, the leaders’ appetite for a more collaborative relationship had grown. They realized that a weak relationship between the two organizations could create an opening for a third, more competitive organization to take market share and that the antagonistic relationship with Haddon was unacceptable.

With great hesitation, Monroe’s leaders asked Mr. Jacobson to approach Haddon’s senior leaders to determine their willingness to explore a closer working relationship. The Haddon group responded with appreciation and agreed to participate in a parallel exercise. Twenty-five of Haddon’s senior leaders considered the paradox, looked at the existing and potential market, and created several scenarios. They concluded that  a more collaborative relationship would serve the interests of both organizations.

The two CEOs discovered that their organizations had common values that could support a healthier bond: they both endeavored to do what was best for their patients and to preserve their hallmark high level of care. Most important, they realized the value of the other organization.

Both leaders agreed that greater collaboration would require managers lower in the organization chart to trust their counterparts and to develop more effective ways of working together. The senior leaders decided to call a joint forum of 40 managers, directors, and physician and administrative leaders from each organization to create a platform for change facilitated by Mr. Jacobson.

Monroe and Haddon participated in a real-time strategic change forum. The methodology encourages large numbers of people from all organization levels and departments to develop more comprehensive solutions and thus reduces resistance to change. Involving critical stakeholders increases engagement and reduces time to implementation.


Several years following the forum, the two organizations completed construction of an integrated campus that has the latest medical technology. Physicians from both organizations collaborate to deliver care.  The jointly planned facility is so well integrated that patients cannot tell which part of the campus belongs to which organization.

In its fifth year of operation, the new facility is ranked in the top 10 percent of best hospitals in the nation with respect to quality. Patients also rank performance in the top 10 percent of US hospitals. The new hospital’s results indicate the lasting relationship between Monroe and Haddon.


By framing cooperation and collaboration as a paradox that involved two polarities that must exist at the same time, participants avoided either/or thinking, which limits the creation of viable alternatives.  New language and leadership tools can help competing parties address contentious issues. Although senior leaders created the platform for change, frontline workers and managers sustained the change effort.

As always, I welcome your input to improve healthcare collaboration and get it done.

Kenneth H. Cohn

© 2011, all rights reserved

Disclosure: I have not received any compensation for writing this content.


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