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For all the hard work to improve coordination and collaboration in health care, most hospitals are still organized into silos based on clinical specialties - and communication among them is uneven at best. Teams may function fairly well within silos, but coordination across them is often poor, which has potentially serious consequences for patients. One coordination breakdown that I studied involved a routine CT scan that should have taken only a few hours from order to execution but, because of failed coordination across silos, took four days. Everyone in the chain did a good job within the confines of their local teams, but they didn’t consider how they fit into the bigger picture.