Social networks of professionals in health care organizations: a review

Exploring the use of social network analysis methods in process improvement within healthcare organizations: a scoping review

BACKGROUND

Communication breakdowns among healthcare providers have been identified as a significant cause of preventable adverse events, including harm to patients. A large proportion of studies investigating communication in healthcare organizations lack the necessary understanding of social networks to make meaningful improvements. Process Improvement in healthcare (systematic approach of identifying, analyzing, and enhancing workflows) is needed to improve quality and patient safety. This review aimed to characterize the use of SNA methods in Process Improvement within healthcare organizations.

METHODS

Relevant studies were identified through a systematic search of seven databases from inception - October 2022. No limits were placed on study design or language. The reviewers independently charted data from eligible full-text studies using a standardized data abstraction form and resolved discrepancies by consensus. The abstracted information was synthesized quantitatively and narratively.

RESULTS

Upon full-text review, 38 unique articles were included. Most studies were published between 2015 and 2021 (26, 68%). Studies focused primarily on physicians and nursing staff. The majority of identified studies were descriptive and cross-sectional, with 5 studies using longitudinal experimental study designs. SNA studies in healthcare focusing on process improvement spanned three themes: Organizational structure (e.g., hierarchical structures, professional boundaries, geographical dispersion, technology limitations that impact communication and collaboration), team performance (e.g., communication patterns and information flow among providers., and influential actors (e.g., key individuals or roles within healthcare teams who serve as central connectors or influencers in communication and decision-making processes).

CONCLUSIONS

SNA methods can characterize Process Improvement through mapping, quantifying, and visualizing social relations, revealing inefficiencies, which can then be targeted to develop interventions to enhance communication, foster collaboration, and improve patient safety.

Factors associated with satisfaction of the australian rural resident medical officer cadetship program: results from a cross-sectional study

BACKGROUND

Australian Rural Resident Medical Officer Cadetships are awarded to medical students interested in a rural medical career. The Rural Residential Medical Officer Cadetship Program (Cadetship Program) is administered by the Rural Doctors Network on behalf of the NSW Ministry of Health. This study aimed to assess the overall experience of medical students and key factors that contributed to their satisfaction with the Cadetship Program.

METHODS

A quantitative cross-sectional study was conducted among 107 former cadets who had completed the Cadetship Program. Data on medical students' experience with the Cadetship Program (outcome variable) and potential explanatory variables were collected using a structured self-administered questionnaire. Explanatory variables included gender, geographical location, rural health club membership, rural clinical school attendance, financial support, mentorship benefits, networking opportunities, influence on career decisions, opportunity for preferential placements, and relocation. Both bivariate (Pearson's chi-squared test) and multiple logistic regression analysis were employed to identify the factors associated with medical students' overall experience with the Cadetship Program. The non-linear analysis was weighted to represent the rural/remote health workforce, in Stata/SE 14.1.

RESULTS

Our results indicate that 91% of medical students were satisfied with the Cadetship Program. The logistic regression model identified two significant predictors of a positive experience with the Cadetship Program. Medical students who perceived financial support as beneficial were significantly more likely to report a satisfactory program experience (aOR = 6.22, 95% CI: 1.36-28.44, p = 0.019) than those who perceived financial support as not beneficial. Similarly, those who valued networking opportunities were more likely to have a positive view of their cadetship experience (aOR = 10.06, 95% CI: 1.11-91.06, p = 0.040) than their counterparts.

CONCLUSION

Our study found that students who valued financial support and networking opportunities had the most positive views of the Cadetship Program. These findings demonstrate that the Cadetship Program may be most helpful for those who need financial support and for students who seek networking opportunities. These findings increase our knowledge about the characteristics of medical students who have the most positive experiences with the Cadetship Program. They help us to understand the mechanisms of influence of such programs on individuals' decisions to be part of the future rural health workforce.

Knowing your team in the intensive care unit: an ethnographic study on familiarity

Effective interprofessional team function is integral to high-quality care in the intensive care unit (ICU). However, little is known about how familiarity develops among teams, which may be an important antecedent to effective team function and quality care. To examine team familiarity and how it impacts ICU team function and care, we conducted an ethnographic study in four ICUs (two medical ICUs, one mixed medical-surgical ICU, and one surgical ICU) in two community hospitals and one academic medical center. We conducted 57.5 h of observation, 26 shadowing experiences, and 26 interviews across the four ICUs sequentially. We used thematic analysis to examine familiarity among the team. We found that ICU team members become familiar with their team through interpersonal, relational interactions, which involved communication, time working together, social interactions, trust, and respect. Our findings underscore the relational aspect of effective teams and demonstrate that time working together, social interactions, communication, developing trust, and respect are pathways to familiarity and optimal team function. Leveraging unique and creative ways to enhance the relational aspects of ICU teams could be an area for future research and lead to improved ICU outcomes.

Social Network Analysis in Undergraduate and Postgraduate Medical Education: A Scoping Review

PURPOSE

Social network analysis (SNA) is a theoretical framework and analytical approach used to study relationships among individuals and groups. While SNA has been employed by many disciplines to understand social structures and dynamics of interpersonal relationships, little is known about its use in medical education. Mapping and synthesizing the scope of SNA in undergraduate and postgraduate medical education can inform educational practice and research.

METHOD

This scoping review was based on searches conducted in Medline, Embase, Scopus, and ERIC in December 2020 and updated in March 2022. After removal of duplicates, the search strategy yielded 5,284 records, of which 153 met initial inclusion criteria. Team members conducted full-text reviews, extracted relevant data, and conducted descriptive and thematic analyses to determine how SNA has been used as a theoretical and analytical approach in undergraduate and postgraduate medical education.

RESULTS

Thirty studies, from 11 countries, were retained. Most studies focused on undergraduate medical students, primarily in online environments, and explored students' friendships, information sharing, and advice seeking through SNA. Few studies included residents and attending staff. Findings suggested that SNA can be a helpful tool for monitoring students' interactions in online courses and clinical clerkships. SNA can also be used to examine the impact of social networks on achievement, the influence of social support and informal learning outside the classroom, and the role of homophily in learning. In clinical settings, SNA can help explore team dynamics and knowledge exchange among medical trainees.

CONCLUSIONS

While SNA has been underutilized in undergraduate and postgraduate medical education, findings indicate that SNA can help uncover the structure and impact of social networks in the classroom and the clinical setting. SNA can also be used to help design educational experiences, monitor learning, and evaluate pedagogical interventions. Future directions for SNA research in medical education are described.

How online healthcare team evolve into organization: A social network analysis

Objective

The rapid development of online healthcare has greatly promoted the transformation of healthcare service. The effectiveness of online healthcare is enhanced by the team that supports the doctor-patient connection. However, extant researches lack the comprehensive analysis of social networks within online healthcare team. In this study, we aim to clarify the characteristics and models of online healthcare team.

Method

This study focuses on the online healthcare context and collects data from online healthcare team. Using social network analysis, the social networks of online healthcare members are also developed as part of the research.

Result

This study uncovers the different modes of online healthcare teams from individual, team and organizational levels. These results shed light on the characteristics of an online healthcare team and show that such teams are capable of restructuring social networks. In addition, collaboration between teams allows for the development of multilevel relationships and the potential for the online healthcare team to evolve into a large-scale online healthcare organization.

Conclusion

Through social network analysis, this study offers a fresh viewpoint on online healthcare and its implications for management, team construction, and organizational restruction. By examining the characteristics and models of online healthcare team, this research offers valuable insights for improving the overall effectiveness of online healthcare.

Surveying Early Intervention Providers to Identify Opportunities for Workforce Support to Strengthen Family-Centered Care

Traditional provider-to-child models of early intervention (EI) service provision have been increasingly replaced by service guidelines that promote a broader family-centered approach to support improvement in the child's primary area of delay. These guidelines include working directly with caregivers and addressing needs of the family that might impact a caregivers' capacity to engage in developmentally supportive interactions with children (e.g., caregiver distress). Knowledge of provider skills, practices, and attitudes would inform efforts to broaden and enhance practice in line with these guidelines. Within an academic-community partnership to support EI, we surveyed 88 providers in Miami and Boston about their usual practice, perceptions of their skills, general attitudes towards evidence-based practices, and interest in specific training opportunities. Findings indicated that providers spent more time working directly with children than caregivers. Providers reported high interest in training to manage caregiver distress, support preschool readiness, and align work with family culture. Negative overall attitudes towards using evidence-based interventions and provider exhaustion were related to less interest in obtaining training in culturally-responsive practice. Exhaustion also related to less interest in training on other topics that represent a broadened scope of care, including building warm parent-child relationships. Findings are informing efforts to design EI training opportunities to improve parent-provider relations, enhance parent-child interactions, and reduce caregiver stress.

A Conceptual Framework for Optimizing the Equity of Hospital-Based Emergency Care: The Structure of Hospital Transfer Networks

Policy Points Current pay-for-performance and other payment policies ignore hospital transfers for emergency conditions, which may exacerbate disparities. No conceptual framework currently exists that offers a patient-centered, population-based perspective for the structure of hospital transfer networks. The hospital transfer network equity-quality framework highlights the external and internal factors that determine the structure of hospital transfer networks, including structural inequity and racism.

CONTEXT

Emergency care includes two key components: initial stabilization and transfer to a higher level of care. Significant work has focused on ensuring that local facilities can stabilize patients. However, less is understood about transfers for definitive care. To better understand how transfer network structure impacts population health and equity in emergency care, we proposea conceptual framework, the hospital transfer network equity-quality model (NET-EQUITY). NET-EQUITY can help optimize population outcomes, decrease disparities, and enhance planning by supporting a framework for understanding emergency department transfers.

METHODS

To develop the NET-EQUITY framework, we synthesized work on health systems and quality of health care (Donabedian, the Institute of Medicine, Ferlie, and Shortell) and the research framework of the National Institute on Minority Health and Health Disparities with legal and empirical research.

FINDINGS

The central thesis of our framework is that the structure of hospital transfer networks influences patient outcomes, as defined by the Institute of Medicine, which includes equity. The structure of hospital transfer networks is shaped by internal and external factors. The four main external factors are the regulatory, economic environment, provider, and sociocultural and physical/built environment. These environments all implicate issues of equity that are important to understand to foster an equitable population-based system of emergency care. The framework highlights external and internal factors that determine the structure of hospital transfer networks, including structural racism and inequity.

CONCLUSIONS

The NET-EQUITY framework provides a patient-centered, equity-focused framework for understanding the health of populations and how the structure of hospital transfer networks can influence the quality of care that patients receive.

Information exchange networks for chronic diseases in primary care practices in Germany: a cross-sectional study

Background

Coordination of care requires information exchange between health workers. The structure of their information exchange networks may influence the quality and efficiency of healthcare delivery. The aim of this study was to explore and classify information exchange networks in primary care for patients with chronic diseases in Germany.

Methods

A cross-sectional study was carried out between 2019 and 2021. As part of a larger project on coordination of care, this study focused on information exchange in practice teams regarding patients with type 2 diabetes (DM), coronary heart disease (CHD) and chronic heart failure (CHF). Social network analysis was applied to determine the number of connections, density and centralization for each of the health conditions for each of the practices. On the basis of the descriptive findings, we developed typologies of information exchange networks in primary care practices.

Results

We included 153 health workers from 40 practices, of which 25 practices were included in the social network analysis. Four types of information exchange structures were identified for the three chronic diseases: highly connected networks with low hierarchy, medium connected networks with medium hierarchy, medium connected networks with low hierarchy and lowly connected networks. Highly connected networks with low hierarchy were identified most frequently (18 networks for DM, 17 for CHD and 14 for CHF). Of the three chronic conditions, information sharing about patients with DM involved the most team members. Information exchange outside the family practice took place mainly with nurses and pharmacists.

Conclusions

This study identified four types of information exchange structures, which provides a practical tool for management and improvement in primary care. Some practices had few information transfer connections and could hardly be considered a network.

Trial registration

We registered the study prospectively on 7 November 2019 at the German Clinical Trials Register (DRKS, www.drks.de) under ID no. DRKS00019219.

So Happy Together: A Review of the Literature on the Determinants of Effectiveness of Purpose-Oriented Networks in Health Care

While purpose-oriented networks are widely recognized as organizational forms to address wicked problems in health care such as increasing demands and expenditure, the associated literature is fragmented. We therefore reviewed empirical studies to identify the determinants of the effectiveness of these networks. Our search yielded 3,657 unique articles, of which 19 met our eligibility criteria. After backward snowballing and expert consultation, 33 articles were included. Results reveal no less than 283 determinants of effective health care networks. The majority of these determinants are processual and involving professionals from the operational level is particularly salient. In addition, most studies relate determinants to process outcomes (e.g., improved collaboration or sustainability of the network) and only a few to members' perception of whether the network attains its goals. We urge future research to adopt configurational approaches to identify which sets of determinants are associated with networks' ability to attain their goal of addressing wicked problems.

An integrative perspective on interorganizational multilevel healthcare networks: a systematic literature review

BACKGROUND

Interorganizational networks in healthcare do not always attain their goals. Existing models outline the factors that could explain poor network performance: governance; structure; and the alignment of professional, organizational and network levels. However, these models are very generic and assume a functional approach. We investigate available empirical knowledge on how network structure and governance relate to each other and to network performance in a multilevel context, to get deeper insight, supported with empirics, of why networks (fail to) achieve their goals.

METHOD

A systematic literature review based on a search of Web of Science, Business Source Complete and PubMed was executed in May 2021 and repeated in January 2022. Full papers were included if they were written in English and reported empirical data in a healthcare interorganizational setting. Included papers were coded for the topics of governance, structure, performance and multilevel networks. Papers from the scientific fields of management, administration and healthcare were compared. Document citation and bibliographic coupling networks were visualized using Vosviewer, and network measures were calculated with UCINET.

RESULTS

Overall, 184 papers were included in the review, most of which were from healthcare journals. Research in healthcare journals is primarily interested in the quality of care, while research in management and administration journals tend to focus on efficiency and financial aspects. Cross-citation is limited across different fields. Networks with a brokered form of governance are the most prevalent. Network performance is mostly measured at the community level. Only a few studies employed a multilevel perspective, and interaction effects were not usually measured between levels.

CONCLUSIONS

Research on healthcare networks is fragmented across different scientific fields. The current review revealed a range of positive, negative and mixed effects and points to the need for more empirical research to identify the underlying reasons for these outcomes. Hardly any empirical research is available on the effects of different network structures and governance modes on healthcare network performance at different levels. We find a need for more empirical research to study healthcare networks at multiple levels while acknowledging hybrid governance models that may apply across different levels.

A double-edged sword: The effects of social network ties on job satisfaction in primary care organizations

BACKGROUND

Social ties between health care workers may be an important driver of job satisfaction; however, research on this topic is limited.

PURPOSE

We used social network methods to collect data describing two types of social ties, (a) instrumental ties (i.e., exchange of advice that enables work) and (b) expressive ties (i.e., exchange of social support), and related those ties to workers' job satisfaction.

METHODOLOGY

We surveyed 456 clinicians and staff at 23 primary care practices about their social networks and workplace attitudes. We used multivariable linear regression to estimate the relationship between an individual's job satisfaction and two network properties: (a) eigenvector centrality (a measure of the importance of an individual in a network) and (b) ego network density (a measure of the cohesiveness of an individual's network). We examined this relationship for both instrumental and expressive ties.

RESULTS

Individuals who were more central in the expressive network were less satisfied in their job, b = -0.40 (0.19), p < .05, whereas individuals who had denser instrumental networks were more satisfied in their job, b = 0.49 (0.21), p < .05.

CONCLUSION

Workplace relationships affect worker well-being. Centrality in an expressive network may require greater emotional labor, increasing workers' risk for job dissatisfaction. On the other hand, a dense instrumental network may promote job satisfaction by strengthening workers' access to full information, supporting competence and confidence.

PRACTICE IMPLICATIONS

Efforts to increase job satisfaction should consider both the positive and negative effects of social networks on workers' sense of well-being.

A social network intervention to improve connectivity and burnout among psychiatry residents in an academic institution: a quasi-experimental study

BACKGROUND

Burnout is common among residents, which could be associated with their professional network characteristics. This study aimed to assess the social networks of psychiatry residents and develop an intervention to improve their network characteristics, burnout, and perception of the educational environment.

METHODS

We recruited a cohort of 17 PGY-2 residents and assessed their social networks, burnout, and perception of the educational environment. After the baseline survey, we held a focus group with PGY-2 residents to discuss the results, their network characteristics, and interventions that can improve their relationships. The PGY-2 residents indicated that offering extracurricular opportunities to facilitate friendly interactions among the residents and faculty members would be the most feasible and acceptable intervention. Therefore, four "interest groups" for extracurricular activities were established. Residents and faculty members were invited to participate in interest groups to improve the network characteristics. Some PGY-2 residents and faculty members agreed to moderate interest group sessions (active members).

RESULTS

After the intervention, active residents improved significantly in the perceived personal accomplishment subscale of the burnout inventory and their perception of the educational environment. Active faculty members also had a significant increase in their relationships with PGY-2 residents in one domain of social networks.

CONCLUSIONS

Enhancing relationships between residents and faculty members through participatory intervention and extracurricular activities can improve faculty-resident connectivity and residents' perception of personal accomplishment and educational environment quality.

The use of social network analysis in social support and care: a systematic scoping review protocol

BACKGROUND

In recent decades, the literature on Social Network Analysis and health has experienced a significant increase. Disease transmission, health behavior, organizational networks, social capital, and social support are among the different health areas where Social Network Analysis has been applied. The current epidemiological trend is characterized by a progressive increase in the population's ageing and the incidence of long-term conditions. Thus, it seems relevant to highlight the importance of social support and care systems to guarantee the coverage of health and social needs within the context of acute illness, chronic disease, and disability for patients and their carers. Thus, the main aim is to identify, categorize, summarize, synthesize, and map existing knowledge, literature, and evidence about the use of Social Network Analysis to study social support and care in the context of illness and disability.

METHODS

This scoping review will be conducted following Arksey and O'Malley's framework with adaptations from Levac et al. and Joanna Briggs Institute's methodological guidance for conducting scoping reviews. We will search the following databases (from January 2000 onwards): PubMed, MEDLINE, Web of Science Core Collection, SCOPUS, CINAHL, PsycINFO, Cochrane Database of Systematic Reviews, PROSPERO, and DARE. Complementary searches will be conducted in selected relevant journals. Only articles related to social support or care in patients or caregivers in the context of acute illnesses, disabilities or long-term conditions will be considered eligible for inclusion. Two reviewers will screen all the citations, full-text articles, and abstract the data independently. A narrative synthesis will be provided with information presented in the main text and tables.

DISCUSSION

The knowledge about the scientific evidence available in the literature, the methodological characteristics of the studies identified based on Social Network Analysis, and its main contributions will highlight the importance of health-related research's social and relational dimensions. These results will shed light on the importance of the structure and composition of social networks to provide social support and care and their impact on other health outcomes. It is anticipated that results may guide future research on network-based interventions that might be considered drivers to provide further knowledge in social support and care from a relational approach at the individual and community levels.

TRIAL REGISTRATION

Open Science Framework https://osf.io/dqkb5 .

Social Network Analysis of an Agricultural Center: Stakeholders and the Transfer of Information

We conducted a social network analysis (SNA) of Central States Center for Agricultural Safety and Health (CS-CASH) to describe stakeholder networks for agricultural Research and Education/Outreach. This was a two-phase study. First, the Leader Survey went to N = 9 CS-CASH leaders to identify their key stakeholders. Next, the Stakeholder Survey was sent to these stakeholders to learn about their stakeholder collaborations, interactions, and communications. The Pajek Network Analysis measured SNA metrics for density, centrality, betweenness, k-core, and created the sociograms. The Leader Survey had a 100% response rate and generated N = 337 unique stakeholders. Most were researchers (44%) and educators (20%), with a primary sphere of influence in Nebraska-only (40%). The Stakeholder Survey had 46% response rate, and generated N = 199 names in the extended Education/Outreach network and N = 140 in the extended Research network. Stakeholders in both networks were employed mostly in universities/schools (61%) or non-profits (15%). Both networks had a single main component and 7/9 CS-CASH leaders had central roles in these components. CS-CASH is well positioned in the extended stakeholder networks based on SNA metrics. Stakeholders utilize CS-CASH resources, and they seek and exchange information with its leaders. To strengthen knowledge transfer, it will be useful to build on connections with stakeholders outside academia.

Review of social networks of professionals in healthcare settings-where are we and what else is needed?

Background

Social Network Analysis (SNA) demonstrates great potential in exploring health professional relationships and improving care delivery, but there is no comprehensive overview of its utilization in healthcare settings. This review aims to provide an overview of the current state of knowledge regarding the use of SNA in understanding health professional relationships in different countries.

Methods

We conducted an umbrella review by searching eight academic databases and grey literature up to April 30, 2021, enhanced by citation searches. We completed study selection, data extraction and quality assessment using predetermined criteria. The information abstracted from the reviews was synthesized quantitatively, qualitatively and narratively.

Results

Thirteen reviews were included in this review, yielding 330 empirical studies. The degree of overlaps of empirical studies across included reviews was low (4.3 %), indicating a high diversity of included reviews and the necessity of this umbrella review. Evidence from low- and middle-income countries (LMIC), particularly Asian countries, was limited. The earliest review was published in 2010 and the latest in 2019. Six reviews focused on the construction or description of professional networks and seven reviews reported factors or influences of professional networks. We synthesized existing literature on social networks of health care professionals in the light of (i) theoretical frameworks, (ii) study design and data collection, (iii) network nodes, measures and analysis, and (iv) factors of professional networks and related outcomes. From the perspective of methodology, evidence lies mainly in cross-sectional study design and electronic data, especially administrative data showing “patient-sharing” relationships, which has become the dominant data collection method. The results about the impact of health professional networks on health-related consequences were often contradicting and not truly comparable.

Conclusions

Methodological limitations, inconsistent findings, and lack of evidence from LMIC imply an urgent need for further investigations. The potential for broader utilization of SNA among providers remains largely untapped and the findings of this review may contain important value for building optimal healthcare delivery networks.

PROSPERO registration number

The protocol was published and registered with PROSPERO, the International Prospective Register of Systematic Reviews (CRD42020205996).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12992-021-00772-7.

Hospital reorganization and its effects on physicians' network churn: The role of past ties

Hospital reorganizations are difficult and often fail to produce their intended benefits. Prior research has investigated how and under which contingencies changes in organizational structure affect the modification of clinician behaviors, yet we know little about how organizational redesign interventions affect physicians' collaborative networks. This paper explores how hospital reorganizations affect physicians' network churn. We developed hypotheses on the relationship between structural characteristics of networks before reorganization and the formation of cross-unit network ties after reorganization. We tested our hypotheses on a sample of 175 physicians in a large teaching hospital. The hospital had recently adopted a new organizational model aimed at enhancing a process-based approach to care delivery. Our findings revealed that the physicians' propensity to form cross-unit ties after the change was related to the structure of their collaborative networks before the change. In particular, the formation of cross-unit relations was negatively related to the size of advice networks before the reorganization. Furthermore, we found that the diversity of network ties along with the presence of structural holes in the physicians' networks before the change moderated this relationship. We discussed the theoretical and practical implications of our findings. In particular, our results may inform organizational redesign interventions within hospitals.

Advancing clinical leadership to improve the implementation of evidence-based practice in surgery: a longitudinal mixed-method study protocol

BACKGROUND

Clinical leadership is fundamental in facilitating service improvements in healthcare. Few studies have attempted to understand or model the different approaches to leadership which are used when promoting the uptake and implementation of evidence-based interventions. This research aims to uncover and explain how distributed clinical leadership can be developed and improved to enhance the use of evidence in practice. In doing so, this study examines implementation leadership in orthopaedic surgery to explain leadership as a collective endeavour which cannot be separated from the organisational context.

METHODS

A mixed-method study consisting of longitudinal and cross-sectional interviews and an embedded social network analysis will be performed in six NHS hospitals. A social network analysis will be undertaken in each hospital to uncover the organisational networks, the focal leadership actors and information flows in each organisation. This will be followed by a series of repeated semi-structured interviews, conducted over 4 years, with orthopaedic surgeons and their professional networks. These longitudinal interviews will be supplemented by cross-sectional interviews with the national established surgical leaders. All qualitative data will be analysed using a constructivist grounded theory approach and integrated with the quantitative data. The participant narratives will enrich the social network to uncover the leadership configurations which exist, and how different configurations of leadership are functioning in practice to influence implementation processes and outcomes.

DISCUSSION

The study findings will facilitate understanding about how and why different configurations of leadership develop and under what organisational conditions and circumstances they are able to flourish. The study will guide the development of leadership interventions that are grounded in the data and aimed at advancing leadership for service improvement in orthopaedics. The strength of the study lies in the combination of multi-component, multi-site, multi-agent methods to examine leadership processes in surgery. The findings may be limited by the practical challenges of longitudinal qualitative data collection, such as ensuring participant retention, which need to be balanced against the theoretical and empirical insights generated through this comprehensive exploration of leadership across and within a range of healthcare organisations.

Uncovering social structures and informational prejudices to reduce inequity in delivery and uptake of new molecular technologies

Advances in molecular technologies have the potential to help remedy health inequities through earlier detection and prevention; if, however, their delivery and uptake (and therefore any benefits associated with such testing) are not more carefully considered, there is a very real risk that existing inequities in access and use will be further exacerbated. We argue this risk relates to the way that information and knowledge about the technology is both acquired and shared, or not, between health practitioners and their patients.A healthcare system can be viewed as a complex social network comprising individuals with different worldviews, hierarchies, professional cultures and subcultures and personal beliefs, both for those giving and receiving care. When healthcare practitioners are not perceived as knowledge equals, they would experience informational prejudices, and the result is that knowledge dissemination across and between them would be impeded. The uptake and delivery of a new technology may be inequitable as a result. Patients would also experience informational prejudice when they are viewed as not being able to understand the information that is presented to them, and information may be withheld.Informational prejudices driven by social relations and structures have thus far been underexplored in considering (in)equitable implementation and uptake of new molecular technologies. Every healthcare interaction represents an opportunity for experiencing informational prejudice, and with it the risk of being inappropriately informed for undertaking (or offering) such screening or testing. Making knowledge acquisition and information dissemination, and experiences of informational prejudice, explicit through sociologically framed investigations would extend our understandings of (in)equity, and offer ways to affect network relationships and structures that support equity in delivery and uptake.

Learning in Faculty Development: The Role of Social Networks

PURPOSE

Faculty development is increasingly acknowledged as an important aspect of health professions education. Its conceptualization has evolved from an individual skills training activity to contemporary notions that draw on an organizational model. This organizational model recognizes relationships and networks as important mediators of knowledge mobilization. Although such conceptual advancements are critical, we lack empirical evidence and robust insights into how social networks function to shape learning in faculty development. The purpose of this study was to understand how informal professional social networks influence faculty development learning in the health professions.

METHOD

This study used a qualitative social network approach to explore how teaching faculty's relationships influenced their learning about teaching. The study was conducted in 2018 in an undergraduate course at a Canadian medical school. Eleven faculty participants were recruited, and 3 methods of data collection were employed: semistructured interviews, participant-drawn sociograms, and demographic questionnaires.

RESULTS

The social networks of faculty participants influenced their learning about teaching in the following 4 dimensions: enabling and mobilizing knowledge acquisition, shaping identity formation, expressing vulnerability, and scaffolding learning.

CONCLUSIONS

Faculty developers should consider faculty's degree of social embeddedness in their professional social networks, as our study suggests this may influence their learning about teaching. The findings align with recent calls to conceptually reorient faculty development in the health professions as a dynamic social enterprise.

[The Early Mobilization Network]

BACKGROUND

Since its foundation in 2011, the German Network for Early Mobilization of mechanically ventilated intensive care patients delivered, among others, more than 90 monthly newsletters, 14 research projects, and 3 national conferences.

PURPOSE

The aim of this online survey was to evaluate whether members of the Network perceived a professional benefit for themselves and their intensive cate units (ICU).

METHODS

An interprofessional online survey of 303 clinicians of the Network in German speaking countries in July 2019 was undertaken. The survey included questions about newsletters, personal benefits, perceived improvements on their workplaces, and future expectations.

RESULTS

The response rate was 48% (n = 145), mainly nurses and physiotherapists. The majority perceived the newsletter as good. Members reported that the network extended their professional knowledge and improved the quality of the ICUs regarding early mobilization, delirium management, and interprofessional goals. Participants expressed a wish for more workshops, case reports, webinars, and other educational possibilities.

CONCLUSIONS

Members of the network Early Mobilization perceived a personal and professional benefit. The network supported quality improvements projects in ICUs. The progress of the network may serve as an example for development of other professional networks.

Promoting rational antibiotic prescribing for non-complicated infections: understanding social influence in primary care networks in Germany

Background

Primary care networks in Germany are formalized regional collaborations of physicians and other healthcare providers. Common goals are optimized healthcare processes and services for patients, enhanced communication, agency for professional concerns and strengthened economic power. In the ARena study (Sustainable reduction of antibiotic-induced antimicrobial resistance), 14 primary care networks in two federal German states aimed to promote appropriate antibiotics use for acute non-complicated infections by fostering awareness and understanding. Factors related to the role of primary care networks were to be identified.

Methods

For this study, audio-recorded telephone interviews were conducted with physicians, non-physician health professionals and stakeholder representatives. Pseudonymized verbatim transcripts were coded using thematic analysis. In-depth analysis was based on the inductive categories ‘social support’, ‘social learning’, ‘social normative pressures’ and ‘social contagion’ to reflect social influence processes. Data generated through a survey with physicians and non-physician health professionals were analyzed descriptively to foster understanding of the networks’ potential impact on antibiotic prescribing.

Results

Social influence processes proved to be relevant regarding knowledge transfer, manifestation of best-practice care and self-reflection. Peer communication was seen as a great asset, the main reason for membership and affirmative for own perspectives. All interviewed physicians (n = 27) considered their network to be a strong support factor for daily routines, introduction of new routines, and continuity of care. They utilized network-offered training programs focusing on best practice guideline-oriented use of antibiotics and considered their networks supportive in dealing with patient expectations. A shared attitude combined with ARena intervention components facilitated reflective management of antibiotic prescribing. Non-physician health professionals (n = 11) also valued network peer exchange. They assumed their employers joined networks to offer improved and continuous care. Stakeholders (n = 7) expected networks and their members to be drivers for care optimization.

Conclusion

Primary care networks play a crucial role in providing a platform for professional peer exchange, social support and reassurance. With regards to their impact on antibiotic prescribing for acute non-complicated infections, networks seem to facilitate and amplify quality improvement programs by providing a platform for refreshing awareness, knowledge and self-reflection among care providers. They are well suited to promote a rational use of antibiotics.

Trial registration

ISRCTN, ISRCTN58150046. Registered 24 August 2017.

Supervisors' pedagogies for supporting interns to learn intra- and interprofessional collaboration: a qualitative and quantitative ego network analysis

This work aims to understand intra- and interprofessional networks of general practitioners (GPs) and ear, nose, and throat specialists (ENT specialists), and in what manner supervisors in these specialties involve interns in their professional network to help them learn intra- and interprofessional collaboration. An egocentric social network approach was used to collect and analyze quantitative as well as qualitative data. For this, semi-structured interviews were held with ten GP and ten ENT specialists. GPs had significantly more interprofessional contacts than ENT specialists (p < .01), with no significant difference in the network sizes of both professions (p = .37). All supervisors involved interns in their (ego)network actively as well as more passively. They actively discussed how collaboration with other professionals evolved, or passively assumed that an intern would learn from observing the supervisors' network interactions. Many supervisors considered the interns' initiative essential in deciding to involve an intern in their network. Although the workplace of GPs differed notably from hospital settings where ENT specialists work, the network sizes of both were comparable. Clerkships at the general practice seemed to provide more opportunities to learn interprofessional collaboration, for example with the medical nurse. Supervisors in both specialties could involve interns more actively in their intra- and interprofessional network while interns could take more initiative to learn collaboration from their supervisors' network.

Data-driven modeling of diabetes care teams using social network analysis

OBJECTIVE

We assess working relationships and collaborations within and between diabetes health care provider teams using social network analysis and a multi-scale community detection.

MATERIALS AND METHODS

Retrospective analysis of claims data from a large employer over 2 years was performed. The study cohort contained 827 patients diagnosed with diabetes. The cohort received care from 2567 and 2541 health care providers in the first and second year, respectively. Social network analysis was used to identify networks of health care providers involved in the care of patients with diabetes. A multi-scale community detection was applied to the network to identify groups of health care providers more densely connected. Social network analysis metrics identified influential providers for the overall network and for each community of providers.

RESULTS

Centrality measures identified medical laboratories and mail-order pharmacies as the central providers for the 2 years. Seventy-six percent of the detected communities included primary care physicians, and 97% of the communities included specialists. Pharmacists were detected as central providers in 24% of the communities.

DISCUSSION

Social network analysis measures identified the central providers in the network of diabetes health care providers. These providers could be considered as influencers in the network that could enhance the implication of promotion programs through their access to a large number of patients and providers.

CONCLUSION

The proposed framework provides multi-scale metrics for assessing care team relationships. These metrics can be used by implementation experts to identify influential providers for care interventions and by health service researchers to determine impact of team relationships on patient outcomes.

Evaluation of multidisciplinary collaboration in pediatric trauma care using EHR data

OBJECTIVES

The study sought to identify collaborative electronic health record (EHR) usage patterns for pediatric trauma patients and determine how the usage patterns are related to patient outcomes.

MATERIALS AND METHODS

A process mining-based network analysis was applied to EHR metadata and trauma registry data for a cohort of pediatric trauma patients with minor injuries at a Level I pediatric trauma center. The EHR metadata were processed into an event log that was segmented based on gaps in the temporal continuity of events. A usage pattern was constructed for each encounter by creating edges among functional roles that were captured within the same event log segment. These patterns were classified into groups using graph kernel and unsupervised spectral clustering methods. Demographics, clinical and network characteristics, and emergency department (ED) length of stay (LOS) of the groups were compared.

RESULTS

Three distinct usage patterns that differed by network density were discovered: fully connected (clique), partially connected, and disconnected (isolated). Compared with the fully connected pattern, encounters with the partially connected pattern had an adjusted median ED LOS that was significantly longer (242.6 [95% confidence interval, 236.9-246.0] minutes vs 295.2 [95% confidence, 289.2-297.8] minutes), more frequently seen among day shift and weekday arrivals, and involved otolaryngology, ophthalmology services, and child life specialists.

DISCUSSION

The clique-like usage pattern was associated with decreased ED LOS for the study cohort, suggesting greater degree of collaboration resulted in shorter stay.

CONCLUSIONS

Further investigation to understand and address causal factors can lead to improvement in multidisciplinary collaboration.

How the study of networks informs knowledge translation and implementation: a scoping review

Background

To date, implementation science has focused largely on identifying the individual and organizational barriers, processes, and outcomes of knowledge translation (KT) (including implementation efforts). Social network analysis (SNA) has the potential to augment our understanding of KT success by applying a network lens that examines the influence of relationships and social structures on research use and intervention acceptability by health professionals. The purpose of this review was to comprehensively map the ways in which SNA methodologies have been applied to the study of KT with respect to health professional networks.

Methods

Systematic scoping review methodology involved searching five academic databases for primary research on KT that employed quantitative SNA methods, and inclusion screening using predetermined criteria. Data extraction included information on study aim, population, variables, network properties, theory use, and data collection methods. Descriptive statistics and chronology charting preceded theoretical analysis of findings.

Results

Twenty-seven retained articles describing 19 cross-sectional and 2 longitudinal studies reported on 28 structural properties, with degree centrality, tie characteristics (e.g., homophily, reciprocity), and whole network density being most frequent. Eleven studies examined physician-only networks, 9 focused on interprofessional networks, and 1 reported on a nurse practitioner network. Diffusion of innovation, social contagion, and social influence theories were most commonly applied.

Conclusions

Emerging interest in SNA for KT- and implementation-related research is evident. The included articles focused on individual level evidence-based decision-making: we recommend also applying SNA to meso- or macro-level KT activities. SNA research that expands the range of professions under study, examines network dynamics over time, extends the depth of analysis of the role of network structure on KT processes and outcomes, and employs mixed methods to triangulate findings, is needed to advance the field. SNA is a valuable approach for evaluating key network characteristics, structures and positions of relevance to KT, implementation, and evidence informed practice. Examining how network structure influences connections and the implications of those holding prominent network positions can provide insights to improve network-based KT processes.

Interdepartmental Spread of Innovations: A Multicentre Study of the Enhanced Recovery After Surgery Programme

BACKGROUND

Spread of evidence-based innovations beyond pioneering settings is essential to improve quality of care. This study aimed to evaluate the influence of a national project to implement 'Enhanced Recovery After Surgery' (ERAS) among colorectal teams on the spread of this innovation to gynaecological procedures.

METHODS

A retrospective observational multicentre study was performed of a consecutive sample of patients who underwent major elective gynaecological surgery in 2012-2013. Ten Dutch hospitals (294 patients) had participated in a colorectal breakthrough project implementing ERAS on a nationwide basis and were assigned to the intervention group. Thirteen hospitals (390 patients) that had not participated in this project acted as controls. Outcome measures were time to functional recovery and total length of postoperative hospital stay. Multilevel models adjusted for clustering and baseline demographics were used for analysis. The uptake of ten selected perioperative care elements was evaluated for each hospital.

RESULTS

The estimated mean difference (95% confidence interval) between the intervention and control hospitals was -0.3 (-0.9 to 0.3) days in the time to recovery and 0.2 (-0.8 to 1.3) days in the total length of hospital stay. The mean (± standard deviation) absolute rate of implemented perioperative care elements per hospital was 28.9 ± 14.9% in the control, versus 29.3 ± 11.1% in the intervention group (p = 0.934).

CONCLUSION

Initial implementation effects seem to be restricted to the participating teams and do not automatically spread to other surgical teams in the same hospital.

Introduction of safety and quality standards for private health care providers: a case-study from the Republic of Srpska, Bosnia and Herzegovina

BACKGROUND

Regulation of private health care providers (PHPs) in middle-income countries can be challenging. Mandatory safety and quality standards for PHPs have been in place in the Republic of Srpska since 2012, but not all PHPs have adopted them yet. Adoption rates have differed among different types of providers. We studied three predominant types of PHPs to determine why the rate of adoption of the standards varies among them.

METHODS

This study used a mixed methods approach, which allowed the integration of both quantitative and qualitative data, to develop an explanatory case study. The case study covered three types of private PHPs: pharmacies, dental practices and specialist practices. Primary data were collected through face-to-face semi-structured in-depth interviews and a self-administered postal survey of private health care providers. Our study's theoretical framework was based on the diffusion of innovation theory.

RESULTS

The rate of adoption of mandatory standards varied among different types of PHP mainly due to four factors: (1) level of concern about negative financial consequences, such as the risk of fines or of losing contracts with the Health Insurance Fund of the Republic of Srpska; (2) availability of information on the standards and implementation process; (3) level of the relevant professional association's support for the introduction of standards; and (4) provider's perceptions of the relevant health chamber's attitude toward the standards. Opinions conveyed to PHPs by peers slightly negatively influenced adoption of the standards at the attitude-forming stage. Perceived gains in professional status did not have a major influence on the decision to adopt standards. All three types of PHPs perceived the same disadvantages of the introduction of safety and quality standards: associated expense, increased administrative burden and disruption of service provision.

CONCLUSIONS

When introducing mandatory quality and safety standards for PHPs, national health authorities need to: ensure adequate availability of information on the relative advantages of adhering to standards; support the introduction of standards with relevant incentives and penalties; and work in partnership with relevant professional associations and health chambers to get their buy-in for regulation of quality and safety of health services.

A scoping review of patient-sharing network studies using administrative data

There is a robust literature examining social networks and health, which draws on the network traditions in sociology and statistics. However, the application of social network approaches to understand the organization of health care is less well understood. The objective of this work was to examine approaches to conceptualizing, measuring, and analyzing provider patient-sharing networks. These networks are constructed using administrative data in which pairs of physicians are considered connected if they both deliver care to the same patient. A scoping review of English language peer-reviewed articles in PubMed and Embase was conducted from inception to June 2017. Two reviewers evaluated article eligibility based upon inclusion criteria and abstracted relevant data into a database. The literature search identified 10,855 titles, of which 63 full-text articles were examined. Nine additional papers identified by reviewing article references and authors were examined. Of the 49 papers that met criteria for study inclusion, 39 used a cross-sectional study design, 6 used a cohort design, and 4 were longitudinal. We found that studies most commonly theorized that networks reflected aspects of collaboration or coordination. Less commonly, studies drew on the strength of weak ties or diffusion of innovation frameworks. A total of 180 social network measures were used to describe the networks of individual providers, provider pairs and triads, the network as a whole, and patients. The literature on patient-sharing relationships between providers is marked by a diversity of measures and approaches. We highlight key considerations in network identification including the definition of network ties, setting geographic boundaries, and identifying clusters of providers, and discuss gaps for future study.

The Importance of External Contacts in Job Performance: A Study in Healthcare Organizations Using Social Network Analysis

There is evidence that relations between physicians and nurses within healthcare institutions might be shaped by informal aspects of such relations and by links to people external to the organization, with an impact on work performance. Social network analysis is underutilized in exploring such associations. The paper aims to describe physicians’ and nurses’ relationships outside their clinical units and to explore what kind of ties are related to job performance. A network analysis was performed on cross-sectional data. The study population consisted of 196 healthcare employees working in a public hospital and a primary healthcare centre in Spain. Relational data were analysed using the UCINET software package. Measures included: (i) sample characteristics; (ii) social network variables; and (iii) team performance ratings. Descriptive statistics (means, medians, percentages) were used to characterize staff and performance ratings. A correlational analysis was conducted to examine the strength of relationships between four different types of ties. Our findings suggest that external ties only contribute to improving the performance of physicians at both the individual and team level. They are focused on the decision-making process about the therapeutic plan and, therefore, might need to seek advice outside the workplace. In contrast, external ties are not relevant for the work performance of nurses, as they need to find solutions to immediate problems in a short period of time, having strong ties in the workplace. Social network analysis can illuminate relations within healthcare organizations and inform the development of innovative interventions.

Sustainable reduction of antibiotic-induced antimicrobial resistance (ARena) in German ambulatory care: study protocol of a cluster randomised trial

Background

Despite many initiatives to enhance the rational use of antibiotics, there remains substantial room for improvement. The overall aim of this study is to optimise the appropriate use of antibiotics in German ambulatory care in patients with acute non-complicated infections (respiratory tract infections, such as bronchitis, sinusitis, tonsillitis and otitis media), community-acquired pneumonia and non-complicated cystitis, in order to counter the advancing antimicrobial resistance development.

Methods

A three-armed cluster randomised trial will be conducted in 14 practice networks in two German federal states (Bavaria and North Rhine-Westphalia) and an added cohort that reflects standard care. The trial is accompanied by a process evaluation.

Each arm will receive a different set of implementation strategies. Arm A receives a standard set, comprising of e-learning on communication with patients and quality circles with data-based feedback for physicians, information campaigns for the public, patient information material and performance-based additional reimbursement. Arm B receives this standard set plus e-learning on communication with patients and quality circles with data-based feedback tailored for non-physician health professionals of the practice team and information material for tablet computers (culture sensitive). Arm C receives the standard set as well as a computerised decision support system and quality circles in local multidisciplinary groups.

The study aims to recruit 193 practices which will provide data on 23,934 patients each year (47,867 patients in total).

The outcome evaluation is based on claims data and refers to established indicators of the European Surveillance of Antimicrobial Consumption Network (ESAC-Net). Primary and secondary outcomes relate to prescribing of antibiotics, which will be analysed in multivariate regression models. The process evaluation is based on interviews with surveys among physicians, non-physician health professionals of the practice team and stakeholders. A patient survey is conducted in one of the study arms. Interview data will be qualitatively analysed using thematic framework analysis. Survey data of physicians, non-physician health professionals of the practice team and patients will use descriptive and exploratory statistics for analysis.

Discussion

The ARena trial will examine the effectiveness of large scale implementation strategies and explore their delivery in routine practice.

Trial registration

ISRCTN, ISRCTN58150046. Registered 24 August 2017.

Electronic supplementary material

The online version of this article (10.1186/s13012-018-0722-0) contains supplementary material, which is available to authorized users.

Applications of network analysis to routinely collected health care data: a systematic review

Objective

To survey network analyses of datasets collected in the course of routine operations in health care settings and identify driving questions, methods, needs, and potential for future research.

Materials and Methods

A search strategy was designed to find studies that applied network analysis to routinely collected health care datasets and was adapted to 3 bibliographic databases. The results were grouped according to a thematic analysis of their settings, objectives, data, and methods. Each group received a methodological synthesis.

Results

The search found 189 distinct studies reported before August 2016. We manually partitioned the sample into 4 groups, which investigated institutional exchange, physician collaboration, clinical co-occurrence, and workplace interaction networks. Several robust and ongoing research programs were discerned within (and sometimes across) the groups. Little interaction was observed between these programs, despite conceptual and methodological similarities.

Discussion

We use the literature sample to inform a discussion of good practice at this methodological interface, including the concordance of motivations, study design, data, and tools and the validation and standardization of techniques. We then highlight instances of positive feedback between methodological development and knowledge domains and assess the overall cohesion of the sample.

Social network analysis in medical education

CONTENT

Humans are fundamentally social beings. The social systems within which we live our lives (families, schools, workplaces, professions, friendship groups) have a significant influence on our health, success and well-being. These groups can be characterised as networks and analysed using social network analysis.

SOCIAL NETWORK ANALYSIS

Social network analysis is a mainly quantitative method for analysing how relationships between individuals form and affect those individuals, but also how individual relationships build up into wider social structures that influence outcomes at a group level. Recent increases in computational power have increased the accessibility of social network analysis methods for application to medical education research.

APPLICATION TO MEDICAL EDUCATION

Social network analysis has been used to explore team-working, social influences on attitudes and behaviours, the influence of social position on individual success, and the relationship between social cohesion and power. This makes social network analysis theories and methods relevant to understanding the social processes underlying academic performance, workplace learning and policy-making and implementation in medical education contexts.

CONCLUSIONS

Social network analysis is underused in medical education, yet it is a method that could yield significant insights that would improve experiences and outcomes for medical trainees and educators, and ultimately for patients.

How Health Care Professionals Use Social Media to Create Virtual Communities: An Integrative Review

Background

Prevailing health care structures and cultures restrict intraprofessional communication, inhibiting knowledge dissemination and impacting the translation of research into practice. Virtual communities may facilitate professional networking and knowledge sharing in and between health care disciplines.

Objectives

This study aimed to review the literature on the use of social media by health care professionals in developing virtual communities that facilitate professional networking, knowledge sharing, and evidence-informed practice.

Methods

An integrative literature review was conducted to identify research published between 1990 and 2015. Search strategies sourced electronic databases (PubMed, CINAHL), snowball references, and tables of contents of 3 journals. Papers that evaluated social media use by health care professionals (unless within an education framework) using any research design (except for research protocols or narrative reviews) were included. Standardized data extraction and quality assessment tools were used.

Results

Overall, 72 studies were included: 44 qualitative (including 2 ethnographies, 26 qualitative descriptive, and 1 Q-sort) and 20 mixed-methods studies, and 8 literature reviews. The most common methods of data collection were Web-based observation (n=39), surveys (n=23), interviews (n=11), focus groups (n=2), and diaries (n=1). Study quality was mixed. Social media studied included Listservs (n=22), Twitter (n=18), general social media (n=17), discussion forums (n=7), Web 2.0 (n=3), virtual community of practice (n=3), wiki (n=1), and Facebook (n=1). A range of health care professionals were sampled in the studies, including physicians (n=24), nurses (n=15), allied health professionals (n=14), followed by health care professionals in general (n=8), a multidisciplinary clinical specialty area (n=9), and midwives (n=2). Of 36 virtual communities, 31 were monodiscipline for a discrete clinical specialty. Population uptake by the target group ranged from 1.6% to 29% (n=4). Evaluation using related theories of “planned behavior” and the “technology acceptance model” (n=3) suggests that social media use is mediated by an individual’s positive attitude toward and accessibility of the media, which is reinforced by credible peers. The most common reason to establish a virtual community was to create a forum where relevant specialty knowledge could be shared and professional issues discussed (n=17). Most members demonstrated low posting behaviors but more frequent reading or accessing behaviors. The most common Web-based activity was request for and supply of specialty-specific clinical information. This knowledge sharing is facilitated by a Web-based culture of collectivism, reciprocity, and a respectful noncompetitive environment. Findings suggest that health care professionals view virtual communities as valuable knowledge portals for sourcing clinically relevant and quality information that enables them to make more informed practice decisions.

Conclusions

There is emerging evidence that health care professionals use social media to develop virtual communities to share domain knowledge. These virtual communities, however, currently reflect tribal behaviors of clinicians that may continue to limit knowledge sharing. Further research is required to evaluate the effects of social media on knowledge distribution in clinical practice and importantly whether patient outcomes are significantly improved.

Veterinary team interactions, part one: the practice effect

Veterinary practices have evolved since the era of solo practitioners working on one site. Today veterinary practices tend to include veterinary surgeons, veterinary nurses, receptionists and business managers, leading to the notion of the veterinary team and the rise of interprofessional working. In addition, practices have grown in size and frequently include several branches, creating a distributed team. Research regarding veterinary teamwork is lacking. This paper uses Social Network Analysis (SNA) to address this issue. SNA measures interactions between members of a network. The types of interactions in practice and the effects of practice size and location (branches) are considered. Information sharing and asking for advice are straightforward, lower order interactions. Problem solving and being influenced by another are complex, higher order interactions. Smaller practices have higher densities of interactions, implying a more cohesive team. However, individuals in smaller practices still do not interact with everyone and therefore actively choose with whom to interact. Practices with little staff rotation across branches experience limited interactions across locations. The results of this study have implications for practices aiming to expand their team, either in a single site or by acquiring more branches. Suggestions for ways to maintain and improve interactions are made.

Knowledge, Beliefs and Practices Regarding Antiretroviral Medications for HIV Prevention: Results from a Survey of Healthcare Providers in New England

Background

Antiretroviral treatment for HIV-infection before immunologic decline (early ART) and pre-exposure chemoprophylaxis (PrEP) can prevent HIV transmission, but routine adoption of these practices by clinicians has been limited.

Methods

Between September and December 2013, healthcare practitioners affiliated with a regional AIDS Education and Training Center in New England were invited to complete online surveys assessing knowledge, beliefs and practices regarding early ART and PrEP. Multivariable models were utilized to determine characteristics associated with prescribing intentions and practices.

Results

Surveys were completed by 184 practitioners. Respondent median age was 44 years, 58% were female, and 82% were white. Among ART-prescribing clinicians (61% of the entire sample), 64% were aware that HIV treatment guidelines from the Department of Health and Human Services recommended early ART, and 69% indicated they would prescribe ART to all HIV-infected patients irrespective of immunologic status. However, 77% of ART-prescribing clinicians would defer ART for patients not ready to initiate treatment. Three-fourths of all respondents were aware of guidance from the U.S. Centers for Disease Control and Prevention recommending PrEP provision, 19% had prescribed PrEP, and 58% of clinicians who had not prescribed PrEP anticipated future prescribing. Practitioners expressed theoretical concerns and perceived practical barriers to prescribing early ART and PrEP. Clinicians with higher percentages of HIV-infected patients (aOR 1.16 per 10% increase in proportion of patients with HIV-infection, 95% CI 1.01–1.34) and infectious diseases specialists (versus primary care physicians; aOR 3.32, 95% CI 0.98–11.2) were more likely to report intentions to prescribe early ART. Higher percentage of HIV-infected patients was also associated with having prescribed PrEP (aOR 1.19, 95% CI 1.06–1.34), whereas female gender (aOR 0.26, 95% CI 0.10–0.71) was associated with having not prescribed PrEP.

Conclusions

These findings suggest many clinicians have shifted towards routinely recommending early ART, but not PrEP, so interventions to facilitate PrEP provision are needed.

Social Networks and Inter-professional Knowledge Transfer: The Case of Healthcare Professionals

This study examines the relationship between the structure of professional networks and patterns of inter-professional knowledge transfer in the healthcare setting. Collecting survey data and qualitative evidence from 118 professionals in a hospital department, we used theory on the sociology of professions and social networks to investigate patterns of knowledge transfer between doctors and nurses. First we found that members of different professions tend to be embedded in distinctive professional cliques, which in turn inhibit effective inter-professional knowledge transfer. Network structure, however, combines with individual characteristics in predicting knowledge transfer patterns. By occupying central positions in closely knit networks, clinical directors can facilitate knowledge transfer patterns between doctors and nurses. And actors who are legitimated both intra-professionally and inter-professionally to occupy brokerage positions in social networks, namely junior doctors and nurse managers, are more likely to gain access to non-redundant, valuable knowledge. The overall picture is one of network structure interplaying with the characteristics of individual actors in shaping the dynamics of professional interactions.