It's All About Relationships

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"We've been written up again!" may be heard in your laboratory. Whether a failure to call a result, error in reporting, or something that doesn't involve the laboratory at all, this kind of attack closes doors, strengthens walls around silos, and destroys real communication. Worse, you may "write up" another department in return to document system failure or blame. One approach to avoid this siege conflict is to build stronger work relationships.

Is Your Lab a Silo?
One business website defines "silo mentality" as what happens when "several departments or groups do not want to share information or knowledge with other individuals in the same company."¹ Silo thinking fosters distrust and an "us against them" mentality. Like its military namesake, a workplace silo creates cultural bunkers with missiles ready to strike.

Business consultant Gary Comerford points out correctly that while silos encourage introversion and decrease organizational efficiency, they are usually efficient within their own structures.² A department's inner workings may be focused on self-preservation, from budgeting to communication to promote the notion of irreplaceability (e.g., "This place wouldn't exist without us"). This creates an illusion of uniqueness but also an assumption that organizational problems are yours (or "theirs") alone to fix.

For example, when a process failure occurs and your laboratory is blamed, a write up from nursing documenting the error can happen very quickly, indicating inner efficiency. The form may include complete information related to the incident -- time the specimen should have been drawn, to whom the result should have been called, etc. -- and seem "open and shut." A problem isn't the system; it's your laboratory.

Your reaction to a silo barrage can be silo thinking itself. For example, your team may quickly investigate with an internal root cause analysis that negates the other team's analysis, concluding that the problem is not as presented, a shared system failure, or outside the laboratory. You may even be correct, writing up the situation in detail. But unless you involve all players in the system, your department's introversion is silo thinking.

Silos may exist because of cultural competition, aggressive team leaders, or fear-based thinking e.g. our department is indispensable. They are reinforced by a false notion of unique knowledge about a system or a sense of moral or intellectual superiority within the system. But modern information systems and ubiquitous online documentation have eliminated the need to isolate data; departments -- silos or not -- are better connected than ever before. It's time to get rid of silo thinking and solve real problems.

Make the Connection
Saul Kaplan, founder of the Business Innovation Factory, writes in Bloomberg Businessweek that we need to think horizontally. "Most innovation doesn't require inventing anything new. It is often just a matter of combining and recombining capabilities across disciplines, organizations, and sectors," he writes. "In doing so, we'll connect unusual suspects in purposeful ways." He cites healthcare as a prime opportunity to connect what he calls "the gray areas between silos."³

Connecting silos is a chance to understand your system from a broader scope. Thinking and acting horizontally -- directly with peers in other disciplines and departments -- sidesteps congested routes of communication. Taking concerns directly to the members of other teams builds trust, establishes real communication, and builds strong coalitions independent of management weaknesses and office politics.

Building Relationships
To make connections you build work relationships. This isn't a technological problem; it's meeting face to face in open, honest communication focused on the common goal of patient care. Here are a few of the guidelines suggested by motivational speaker Ty Howard:⁴ 

• Be positive. A positive attitude is contagious and inspiring. Others will enjoy and look forward to interacting with you.
• Accept differences. A different point of view is only that. Forget cultural and gender stereotypes and focus on goals to succeed.
• Give respect to earn it. Active listening, politeness, and a professional demeanor go a long way in changing attitudes toward your laboratory. People often reciprocate respect rather than give it away.
• Share credit. Everyone likes to be recognized for hard work done, and this especially applies to teams. Sharing recognition and rewards with other teams enhances your common experience in solving problems.
• Avoid gossip. Gossip quickly erodes trust and destroys relationships. If you refuse to engage with gossips and avoid the rumor mill, it will also add to your reputation as a team player.

Acting professional involves all these things, in addition to completing work on time, following through on promises, and attention to detail. But relationships also involve the human element that makes work fun. Attention to the social aspects of interactions is revealing and rewarding. Asking other team members about their life outside work, sharing jokes, or engaging in casual talk about a TV show, movie, or ball game is a great start. It reminds everyone that we all have more in common than not.

Workplace parties, picnics, and other social functions that reach across disciplines accomplishes this social function. But there are always opportunities at work breaks, lunches, and rounding to different areas. It can be a relief, for example, for a busy nurse to see you arrive with a smile and a wave. Building trust starts with something simple as a sincere "How is your day going?"

As with all human relationships, building trust takes time. Understanding the needs of the other team members involves effort and interest. Much of this can be done openly and without management interaction. Managers want a cohesive team with high camaraderie, and if it increases efficiency and recognition, so much the better. In time an "error" will be seen as a system failure to be fixed by all parties involved, with the players acknowledging the human element.

Building stronger work relationships isn't just good for business, it's good for you. You will enjoy your work more and find other teams more approachable. That gives you more energy to focus on the important job of providing better patient care.

Scott Warner is lab manager at Penobscot Valley Hospital, Lincoln, ME.

References

1. Investopedia web site. Silo mentality. Available at: www.investopedia.com/terms/s/silo-mentality.asp#axzz2AlWq1Khn. Last accessed Oct. 30, 2012.
2. Comerford G. Silo thinking and why it is bad. Available at: http://process-cafe.blogspot.com/2010/01/silo-thinking-and-why-it-is-bad.html. Last accessed Oct. 30, 2012.
3. Kaplan S. Innovators, break down those silos. Available at: www.businessweek.com/innovate/content/feb2010/id2010028_390003.htm. Last accessed Oct. 30, 2012.
4. Howard T. 12 Quick strategies to build and maintain healthy relationships at work. Available at: http://untietheknots.com/blog/?p=737. Last accessed Oct. 30, 2012.