Bakewell Francis
Dalhousie University, Halifax, Nova Scotia, Canada.
Healthc Manage Forum. 2025 Mar;38(2):148-151. doi: 10.1177/08404704241290689. Epub 2024 Oct 18.
This article explores the concept of medical silos, particularly within hospital systems, and examines their deeper roots in social identity and the fiduciary duty of care of healthcare providers. While traditional perspectives focus on informational and communication barriers, this analysis highlights how professional identity and moral obligations contribute to the persistence of silos. Social identity theory reveals that strong in-group affiliations, formed during medical training and specialization, fosters collaboration within groups but also create divisions between them. Similarly, the fiduciary duty of care, central to ethical medical practice, may inadvertently reinforce silo boundaries in resource-limited environments. By emphasizing the role of centralized leadership, the article proposes that health system managers and leaders, with the broadest possible duty of care, must take action to dismantle these barriers. Recommendations include re-evaluating policies for patient transitions and fostering integrated care pathways to improve overall system flow, rather than simply balancing the agendas of stakeholders within their silos.
本文探讨了医疗孤岛的概念，尤其是在医院系统中的情况，并审视了其在社会认同以及医疗服务提供者的信托责任方面的更深层次根源。虽然传统观点聚焦于信息和沟通障碍，但本分析强调了专业认同和道德义务如何导致孤岛现象的持续存在。社会认同理论表明，在医学培训和专业化过程中形成的强烈的群体内归属感促进了群体内部的协作，但也造成了群体之间的分化。同样，作为道德医疗实践核心的信托责任，在资源有限的环境中可能会无意中强化孤岛界限。通过强调集中领导的作用，本文提出，负有尽可能广泛的照护责任的卫生系统管理者和领导者必须采取行动消除这些障碍。建议包括重新评估患者转诊政策，促进整合的照护路径以改善整个系统的流程，而不是仅仅平衡孤岛内利益相关者的议程。
