Can Silo-ed Leadership Work Together Effectively?

All week I’ve been chewing on David Chou’s recent article about running health care IT as a business. David makes a pretty solid case for why hospital CIOs should become essentially the CEO of the hospital IT business. There’s a lot of value in a leader taking that type of responsibility and forward thinking approach to their organization. However, it can also lead to some interesting challenges.

This concept has been extended as I’ve attended the RSNA (radiology) conference in Chicago. Many of the same messages are being shared with radiologists about leading their organization and about being proactively involved with the patient. You could say that radiologists are being encouraged to run their departments as if they’re CEO of the radiology department.

While this seems like sound advice it should also come with a partial caution. If you’re not careful this can lead to a lot of conflict between various fiefdoms. Everyone feels like they’re the “CEO” and so that ownership and leadership can make it hard for them to work with others. It takes a really powerful leader to bring together department heads who see themselves as CEOs.

A great example of the consequences of this silo-ed leadership is illustrated by what we call shadow IT. For those not familiar with shadow IT, it’s IT purchases and implementations that happen outside of IT. It essentially operates in “the shadows” as opposed to out in the open. This is often purchased with department budget and is usually some sort of hosted application and so departments are able to implement their IT project without the involvement of the main IT organization.

A department head that felt like CEO of their department would have little to no issue with a shadow IT purchase. They rationalize that they can’t wait for IT because if they wait for IT it will never get done. In fact, going around IT seems like the right option since it gets them access to a tool or technology that they need to provide better patient care. That’s what you should want your leaders to do no? Provide the best patient care possible.

Unfortunately, shadow IT has lots of challenges. For example, did they think about the long term cost of supporting the shadow IT system? Did they ensure that the shadow IT system met all the HIPAA security requirements? Did they vet the vendor to ensure that they would be a good long term choice? etc etc etc.

It’s a real challenge for these internal “CEOs” to balance the needs of their department against the needs of the organization as a whole. Many times they’ll get it wrong and it will be lock the gears of an engine or clock that aren’t aligned quite right. It can grind things to a halt. However, with the right leader in place, all of the gears can be leaders within their own departments while still working together nicely with all the other leaders around you.

Isn’t that the real challenge of leadership? Get everyone on board with the same vision, but leave them enough flexibility that they can surprise you with their results.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference,, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.