Healthcare Silos: Building Bridges Between Islands
The right to health is a fundamental human right. We, as human beings, consider health as one of our most basic and essential assets. Health entitlement knows no boundaries and full enjoyment should be the minimum standard for all, irrespective of age, gender, socio-economic status or ethnic background. The classic and most widely held definition of health, was first articulated in the 1946 Constitution of the World Health Organization (WHO), whose preamble defines it as:
“A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”
Ill-health, on the other hand, produces a host of physical, social and economic consequences not just for the individual, but their family and wider networks too. It can prevent us from attending school, managing work duties or fully participating in community activities. By the same token, we are willing to make many sacrifices if only that would guarantee us and our families a longer and healthier life.
One step further in the Constitution, is the right to the “highest attainable standard of health”. The concept is not new, and can be broken down into six distinct elements, that is:
Availability
Accessibility
Acceptability
Quality
Participation
Accountability
In other words, the highest attainable standard is comprehensive biopsychosocial care delivered through integrated, consistent and effective systems. Ones that are responsive to the needs of the individual and local and national populations. Yet in a country that outperforms on multiple indices, many are still falling through the cracks, giving light to convoluted systems of operation in place
Case Study: Swimming Between Islands
Ms Arrows was hospitalised after a violent incident at home. Desperately fleeing the family violence she hastily settles in metropolitan Sydney with her three young children.
Her new doctor cannot continue care without confirmation of existing medical conditions. “This is our first consultation, I cannot write a supporting letter or provide scheduled medication without evidence. I hope you understand”, explains Dr. Jones.
“But I had no time to organise this when leaving Melbourne?”, Ms Arrows exclaims, “and besides I’ve visited two or three medical centres, I’ve never really stuck to one”.
Unperturbed, Ms Arrows requests each record, following the monopoly of rules set up by each individual medical practice. “We ask for up to two weeks to process the request”, one receptionist says. “The patient needs to pay a $30 printing fee”, another remarked. “We don’t release specialist letters. Your new doctor must contact the psychiatrist himself”, explains another, and finally, “We don’t have your discharge summary on file. You need to call the hospital for that”.
For Ms Arrows to obtain her necessary records and vital medications she must jump through bureaucratic hoops that hold little to no regard for her recent traumatic experiences, financial capacity, or mental wellbeing. This is the silo effect, whereby individuals are forced to swim between isolated systems of care, or risk sinking.
Who Builds The Bridges?
Ms Arrows represents only a minute snapshot of the wide-ranging difficulties caused by healthcare silos, that is the phenomena of substandard to no integration between medical record keeping systems, professionals, institutions, and service sectors. Navigating such complex systems assumes that people hold the technology and/or present capacity to do so.
In recent years, increasing attention has been drawn towards examining the barriers produced by healthcare silos. Silos violate the constitutional components of ‘quality’ and ‘accessibility’, which posits that health care should be physically, economically and information accessible to all members of a population. Consider individuals experiencing homelessness, culturally and linguistically diverse populations or those in crisis. A human rights approach to health care ensures that the most vulnerable and marginalised aren’t subject to unnecessary retrogression. Consumers should not be left to forge their own bridges between islands.
Change requires heavy analysis and monitoring of the systems, policies, and procedures already in place. Something as peripheral as strengthening links between providers and organisations has the potential to positively impact the quality of health for many. Building bridges between healthcare silos is a crucial yet overlooked step in progressively moving towards the highest attainable standard of health.