BMJ Qual Saf 21:239-249 doi:10.1136/bmjqs-2011-000187
  • Systematic review

Health professional networks as a vector for improving healthcare quality and safety: a systematic review

Open Access
  1. Jeffrey Braithwaite1
  1. 1Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, Sydney, Australia
  2. 2Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, University of New South Wales, Sydney, Australia
  1. Correspondence to Dr Frances C Cunningham, Centre for Clinical Governance Research, Australian Institute of Health Innovation, Level 1, AGSM Building, University of New South Wales, Sydney, NSW 2052, Australia; f.cunningham{at}
  1. Contributors All authors contributed to the manuscript. Frances Cunningham, Jeffrey Braithwaite and Johanna Westbrook contributed to the overall conceptualisation and study design of the systematic review. All authors, Frances Cunningham, Geetha Ranmuthugala, Jenny Plumb, Andrew Georgiou, Johanna Westbrook and Jeffrey Braithwaite reviewed, contributed to and agreed on the systematic review methodology and the conduct of the review. All authors contributed to writing the manuscript, and all authors have agreed on the final version of the manuscript.

  • Accepted 1 November 2011
  • Published Online First 30 November 2011


Background While there is a considerable corpus of theoretical and empirical literature on networks within and outside of the health sector, multiple research questions are yet to be answered.

Objective To conduct a systematic review of studies of professionals' network structures, identifying factors associated with network effectiveness and sustainability, particularly in relation to quality of care and patient safety.

Methods The authors searched MEDLINE, CINAHL, EMBASE, Web of Science and Business Source Premier from January 1995 to December 2009.

Results A majority of the 26 unique studies identified used social network analysis to examine structural relationships in networks: structural relationships within and between networks, health professionals and their social context, health collaboratives and partnerships, and knowledge sharing networks. Key aspects of networks explored were administrative and clinical exchanges, network performance, integration, stability and influences on the quality of healthcare. More recent studies show that cohesive and collaborative health professional networks can facilitate the coordination of care and contribute to improving quality and safety of care. Structural network vulnerabilities include cliques, professional and gender homophily, and over-reliance on central agencies or individuals.

Conclusions Effective professional networks employ natural structural network features (eg, bridges, brokers, density, centrality, degrees of separation, social capital, trust) in producing collaboratively oriented healthcare. This requires efficient transmission of information and social and professional interaction within and across networks. For those using networks to improve care, recurring success factors are understanding your network's characteristics, attending to its functioning and investing time in facilitating its improvement. Despite this, there is no guarantee that time spent on networks will necessarily improve patient care.


  • Funding This study was funded by the Australian Research Council Discovery Project (ARC DP0986493) and in part by the National Health and Medical Research Council Program Grant (NHMRC 568612). ARC: funder of this study as part of overall project; NHMRC: funder of co-author, Jeffrey Braithwaite.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

Open Access

Free sample

This recent issue is free to all users to allow everyone the opportunity to see the full scope and typical content of BMJ Quality & Safety.
View free sample issue >>

Email alerts

Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.


Navigate This Article