Table 2

Key structural network findings for health network quality and safety

Network featureKey structural findings for health network quality and safetyStudies
  • Important in bridging connections and obviating ‘structural holes’ in hospitals

  • Good coding performance is associated with a knowledge sharing network structure rich in brokerage and hierarchy, rather than density

Heng et al (2005),26 West and Barron (2005),27 Rangachari (2008)28
  • Centrality of key organisations or actors in a network is important, and can be a strength or potential vulnerability for network sustainability

  • Directors of nursing are more central in their networks than clinical directors of medicine and their networks are more hierarchical—hence better adapted to gathering and disseminating information

  • The higher the centrality of the hospital in its network, the better the hospital performance

Cott (1997),29 Creswick and Westbrook (2007),30 Creswick et al (2009),31 Gold et al (2008),32 Lewis et al (2008),33 Mendel et al (2009),34 Mossholder et al (2005),35 Webster et al (1999),36 West and Barron (2005),27 West et al (1999),37 Peng et al (2006)38
Degrees of separationAnalysis of ‘degrees of separation’ can show the level of connectivity in a professional networkCreswick et al (2009)31
  • The denser the GP network the lower the variation in performance

  • Clinical directors of medicine are embedded in more densely connected networks (cliques), than directors of nursing, and can be stronger instruments for changing, or resisting changes, in clinical behaviour. Networks of directors of nursing have lower density, with advantages in accessing information

Fattore et al (2009),39 West et al (1999),37 West and Barron (2005)27
  • Ideological tension can block the spread of knowledge and new work practices within the professional network

  • Gaps in the network of informal ties will impede the dissemination of information and the spread of social influence between nurse executives and physician leaders, while non-clinical managers have a brokerage role

Ormrod et al (2007),40 West and Barron (2005)27
  • People seek advice, or influence or discuss important professional matters with those similar to themselves (profession, gender, age, seniority), with implications for communication exchanges

  • Physician leaders have more extreme homophily than senior nurses

Chase (1995),41 Cott (1997),29 Creswick and Westbrook (2007),30 Creswick et al (2009),31 MacPhee (2000),42 MacPhee and Scott (2002),43 Webster et al (1999),36 West and Barron (2005),27 West et al (1999)37
  • A large number of people in the network seek information from particular individuals

  • For health professional teams other than medicine, collaboration on problem-solving and decision-making is limited to higher status professionals

  • Nursing networks are more hierarchical than medical networks

Creswick and Westbrook (2007),30 Cott (1997),29 West et al (1999)37
Integration and cliques
  • Relationships between groups of agencies, services or providers (cliques) in a network may be more important than the relationship between all agencies in the network

  • SNA can identify agencies and actors who are not well linked in the network

Calloway et al (1999),44 Lemieux-Charles et al (2005),45 Milward and Provan (1998),46 West et al (1999)37
MultiplexityEmployees forming a greater number of ties with co-workers are more embedded and have lower turnoverMossholder et al (2005)35
Network rolesIndividual roles in networks are important for communication and information dissemination: ‘broker’ and ‘bridging’ roles, ‘cliques’, ‘isolates’Gold et al (2008),32 Heng et al (2005),26 Mendel et al (2009),34 Lewis et al (2008),33 West et al (1999),37 West and Barron (2005)27
Network stability
  • Network stability is related to network effectiveness, and can moderate the impact of resources

  • Longitudinal SNA can measure network expansion, with decreased fragmentation increasing potential information flow

Milward and Provan (2003),47 Mendel et al (2009)34
ReciprocityReciprocity of ties shows whether there is a hierarchical (low reciprocity) or horizontal (high reciprocity) structure in the professional networkCreswick and Westbrook (2007),30 Creswick et al (2009)31
Social capital
  • Organisational social capital, in addition to professional experience and workload, can predict overall job satisfaction

  • Social influence of peer professionals has a greater impact than social capital on health professional performance

Ommen et al (2009),48 Fattore et al (2009)39
Social climate
  • Positive social climate protects nurses against burnout

  • Professional and social networks and support do not mitigate against work stress of chief manager nurses or physician clinical directors

Garrett and McDaniel (2001),49 Lindholm (2006),50 Lindholm et al (2003),51 Lindholm et al (2004)52