Article Text

Health professional networks as a vector for improving healthcare quality and safety: a systematic review
  1. Frances C Cunningham1,
  2. Geetha Ranmuthugala1,
  3. Jennifer Plumb1,
  4. Andrew Georgiou2,
  5. Johanna I Westbrook2,
  6. 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}


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.

  • Social networks
  • health professionals
  • review
  • quality improvement
  • organisational structure
  • health services research
  • organisational theory
  • healthcare quality improvement
  • evaluation methodology
  • information technology
  • nursing homes
  • medication error
  • quality of care
  • interruptions
  • patient safety
  • leadership
  • governance

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

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  • 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.

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