Article written by: John Weeks, Executive Director, Academic Consortium for Complementary and Alternative Health Care (ACCAHC)
Nice silo!
Sometimes black humor is the right ice-breaker.
So when I participate in interprofessional education/care gatherings lately on behalf of the Academic Consortium for Complementary and Alternative Health Care (ACCAHC – www.accahc.org), I sometimes use this line: Our silos are bigger than your silos.
It usually gets a laugh.
Being in a silo is nothing to boast about, of course, unless you are talking about getting a crop in prior to a freeze. The line gets a laugh because it acknowledges a reality.
ACCAHC’s core members are the councils of colleges, accrediting agencies and certification and testing organizations for the 5 licensed so-called complementary and alternative medicine (CAM) disciplines of – acupuncture and Oriental medicine, chiropractic, massage therapy, naturopathic medicine and direct-entry (homebirth) midwifery. We are U.S. based. Some of our organizational memberships for the doctoral level fields of chiropractic and naturopathic medicine are Canadian-U.S.
No one questions the statement.
First, there are the historic cultural divides and residual polarizations from these fields growing up as “alternative” healthcare choices for people.
Criticism is not the optimal way to begin a relationship. Yet explicit or implicit criticism of the status quo was and still is – while diminishing – a part of a person’s decision to explore alternatives, either as a patient or as a student. Even when not present in the “alternative” practitioner or the user of the “alternative” services, the decision to leave the norm can still be felt as criticism and rejection by those left. Most of us take such things personally.
This is the software of these silos – the programming, if you will.
The good news is that the last 15 years of a growing “integration” movement has melted some of the iciness of the historic cold war, for all parties. ACCAHC is actively engaged in lowering barriers. But this residual thinking continues to caulk the bricks that maintain the separation between these and conventional disciplines and keep the patient from being the center of professional exchanges.
The more significant silo is the actual hardware of the bricks themselves.
Virtually all of the programs, schools, colleges and now even universities that educate the members of the ACCAHC disciplines are physically separate from academic health centers. In 2009, there were 185 programs in these 5 disciplines that are accredited through US Department of Education-recognized accreditation agencies. (See table on page 11 of ACCAHC’s Clinicians’ and Educators’ Desk Reference on the Licensed Complementary and Alternative Healthcare Professions.) Virtually all of these are stand-alone entities.
Picture a Western tableau of members of a community pitching in to raise an edifice in the middle of the plains. Okay, in the more modern iteration, the school may more likely be in rented space in a business park or office building. No governmental funding supported the bricks and mortar or rent. Chances are that very little if any philanthropy helped out. Some of these educational entities have grown to become significant, multipurpose institutions, with gorgeous campuses, policy centers and research institutes – a small subset of which today has federal research support.
Great silo!
Yet there they sit: pure silos relative to the medical, nursing, pharmacy, PT, social work and other professional programs in academic health centers where, through the IPE/C movement, leaders are trying to break down metaphorical silos.
And what do academic programs in these “CAM” schools do? To date, they mainly graduate professionals to go out into communities and hang up shingles to practice solo. If in shared space, it is most often with colleges from their own fields. We are seeing some changes but this remains the norm.
So this bit of dark humor combines the challenging software of what humans tend to do with decades of isolation and not-knowing another, together with the hardware of the separate physical locations of the facilities and practices.
No doubt: Our silos are bigger than your silos.
Inside ACCAHC, we have aggregated key organizations and teams from across our disciplines to work on mending those rifts. ACCAHC is fundamentally an IPE/C organization. The challenges are many. We’re making some headway which I hope to share in a subsequent post. For a preview, go to http://accahc.org/accomplishments.
Meantime, we are pleased to be connected to the CIHC community. Learning from CIHC is part of the ACCAHC strategy.
Note: While the author serves as the executive director of ACCAHC, this posting has not been pre-approved by the ACCAHC Board of Directors and thus reflects his own views.
In my opinion, professions are stuck in these silos because of the old-fashioned culture of a hierarchal structured system. We as health care professionals all need to get over ranking ourselves as being more or less important fields and bring a wrecking ball to this silo mentality as it suffocates patient-centered care. We are a team and our patients, their needs, wants, cultures and values should be at the centre of all decisions – be they conventional, complementary or alternative. Our patients are trusting us to provide educated insight into all options available to them. How can we plan on competently doing this if there isn’t mutual trust, respect and understanding from all healthcare fields?
So everyone, by all means, sit in your silos; build them up tall and strong and unyielding. The only people who suffer as a result of all our lack of interprofessional communication, education and collaboration are our patients. Happy?
Hi LW
Thank you for your excellent comment! Really valuable insights and we appreciate the honesty and passion.
Best,
Sean
I find the “patient-centered” concept fascinating in the IPE world relative to “CAM” professionals. Common sense suggests that if people are using alternative or complementary or integrative approaches and practitioners then these disciplines would be at the table. That’s patient-centered. Yet provider-centered lines continue to be drawn in defining who is and who isn’t at the table to engage patient-centered IPE. It’s unfortunately not just the “CAM” fields that can be excluded or kept at bay as second-class citizens. Psychologists, social workers, physical therapists and other allied health professions are not allowed in leadership in some important dialogues and organizations. Some say that incremental-ism is good. I am glad these incremental steps are being made. But I say: let’s not replace one hierarchy with another. Good points LW.