The COVID surge of 2021 is an experience I’ll never forget—and I certainly wouldn’t want to relive it.
I was working as a nurse leader in a large metropolitan ER, and we were drowning in patients—30, 40, sometimes 50 of them waiting for care while every one of our 40 ER beds was full. To make things worse, staffing shortages weren’t just affecting us; they hit the entire hospital. Inpatient units had beds available but couldn’t open them due to a lack of staff. It was a bottleneck nightmare, and a textbook example of what happens when silos exist in healthcare.
Then, the breaking point: we sent a patient upstairs to an inpatient floor with an available bed, only to have them sent back down to the ER because the room "wasn’t ready." My charge nurse—who was practically radiating frustration—handed me the phone and said, "I cannot communicate with this inpatient charge nurse anymore. I’m gonna lose my mind. Can you please take this over?" This was my cue.
I rang up the inpatient charge nurse and got the standard delays: the room wasn’t cleaned yet, and the nurse assigned to that bed was on break. Under normal circumstances, I’d be like, "No problem. We’ll hold the patient for 30 minutes." But this wasn’t a normal day. I was already seeing potential MI patients being treated in hallways, and there were 40 people in the waiting room with nowhere to go. The clock was ticking.
I decided to take this conversation offline and go upstairs to speak to the charge nurse face-to-face. As I rode the elevator, I thought about how I wanted to approach her: not as someone issuing demands, but as someone asking for help and offering solutions. When I met her, I was honest and kind. I laid it all out—the chaos downstairs, the patient safety concerns, and how desperate we were to move even one patient upstairs. I even offered to clean the room myself if needed.
Her response? "Wow, is it really that bad?"
"It’s worse," I said.
Within minutes, we had a plan. She called the nurse from her break early, and I personally brought the patient upstairs. What could have been a long standoff between departments turned into an example of what happens when you break down silos and build connections.
What Are Silos, and Why Are They a Problem in Healthcare?
Silos in healthcare occur when departments or groups work independently, unaware of each other’s challenges, workflows, or needs. Imagine a row of grain silos standing tall on a farm—each holding its own contents but completely separate. In healthcare, this separation means that people don’t collaborate effectively, creating delays, bottlenecks, and sometimes life-threatening situations.
My experience that day in the ER exemplified this problem. The inpatient charge nurse had no idea how bad things were in the ER—how critical the need for open beds had become.
This lack of awareness wasn’t intentional, but it was dangerous.
Silos limit collaboration, create an “us versus them” mentality, and make it harder to deliver the high-quality care that we all want to provide.
Breaking Down Silos: What It Takes to Build an Interconnected System
Instead of functioning as disconnected towers, healthcare teams should resemble a dense, interconnected spiderweb—with lines of communication and trust linking every department and individual. So, how do we get there? I’ve identified four key steps to help shift from siloed departments to a collaborative, trust-driven organization.
Step 1: Start by Breaking Silos Within Your Own Team
We naturally form close-knit groups at work, especially when dealing with high-stress environments like healthcare. These groups build trust, camaraderie, and a sense of belonging—all of which are good things. But there’s a downside: the potential for groupthink, othering, and scapegoating.
Practical Tip: Watch Out for the “Us vs. Them” Mentality
Example: In the ER, Night Shift nurses may often blamed day shift for leaving broken equipment or unresolved tasks. Perhaps “Of course Day Shift didn’t report this,” is a common complaint.
What You Can Do: Challenge this mindset. Instead of jumping on the blame train, acknowledge that the other team might have had a rough day or faced unexpected issues. This simple shift can reduce tension and foster understanding.
Build Bridges Within Your Group
Look for ways to create connection between subgroups—for example, between night and day shift, or between nurses and CNAs. This could be as simple as:
Coordinating breaks to get to know someone from a different shift
Inviting a coworker out for coffee or drinks
Creating opportunities for informal collaboration, like combined shift huddles
Step 2: Build Trust and Communication with Your Leaders
I know this might sound daunting, especially if you’re not a fan of your manager. But building a strong relationship with your boss is one of the most strategic moves you can make as a changemaker.
Why This Matters:
Managers play a critical role in advocating for frontline staff, securing resources, and solving problems. Without a strong connection, misunderstandings, delays, and missed opportunities for collaboration are more likely.
Practical Tip: Don’t Avoid Your Manager—Engage Them
Be Approachable: Smile, wave, and acknowledge them when you pass in the hallway.
Check In Regularly: If you work night shift or an off schedule, be intentional about scheduling brief one-on-ones. Even a 15-minute conversation once a month can go a long way.
Ask Questions: Show genuine curiosity about their work, their perspective, and their challenges. For example, ask: “What’s something you wish more people understood about leading this unit?”
Step 3: Break Surface-Level Niceties with Other Departments
Cross-department collaboration can’t just rely on polite hallway greetings and small talk. To truly break down silos, you need to develop deeper relationships and mutual understanding.
Practical Tip: Go Beyond Small Talk
Example: When you’re in the elevator with a CNA from another department, ask a more personal question like, “Did you grow up around here? I think I hear a Midwest accent.”
Why This Works: Deeper questions help build trust and form connections. The next time you interact with that person during a high-pressure situation, they’ll remember that you took the time to connect with them.
Real connections reduce defensiveness and foster collaboration because people see you as someone they know and trust—not just another anonymous coworker.
Step 4: Become a Connector
Being well-connected yourself is great, but the real magic happens when you help others connect, creating a dense network of relationships within your organization.
Practical Tip: Make Introductions
When you’re talking to a coworker, think about who else they should meet. For example: “Have you met Tom from Respiratory Therapy? He’s great at troubleshooting vents.”
Small introductions like this can have ripple effects, strengthening the web of trust and collaboration across departments.
The Firework vs. Webbed Network
My friend Chloé Nwangwu (who we were lucky to have as a guest lecturer inside of Change Maker Essentials), explains this concept beautifully. She describes the difference between a "firework network," where connections only radiate out from one central person, and a "webbed network," where everyone is interconnected. The webbed approach is what allows for true collaboration, because when everyone knows and trusts each other, solutions emerge more quickly, and problems don’t get stuck in bureaucratic limbo.
Final Thoughts: Start Small and Build Connections Over Time
That day in the ER, the breakthrough happened not because of a magic protocol, but because of human connection. By meeting the inpatient charge nurse face-to-face, empathizing with her situation, and painting a clear picture of our crisis, I was able to break down the wall between our departments and get patients the care they needed.
Breaking down silos doesn’t require massive organizational change—it starts with small, intentional actions. This week, choose one of the steps outlined above and commit to practicing it at least three times. Whether it’s having a meaningful conversation with a coworker, checking in with your manager, or making an introduction, every connection you build strengthens the spiderweb of collaboration.
Over time, these small actions add up, creating a healthier, more functional system that benefits everyone—especially our patients.
Want to dive deeper into lessons like these? You can listen to blogs like this on the Nursing the System Podcast. And you can join my email list for weekly lessons and frameworks pulled directly from my day-to-day as a nurse leader in the health innovation space.
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