Understanding the value of social network analysis in healthcare
Communication breakdowns among healthcare providers have long been identified as a significant cause of preventable adverse events, including patient harm. However, 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, which involves a systematic approach to identifying, analyzing, and enhancing workflows, is critical for improving quality and patient safety.
This article aims to characterize the use of social network analysis (SNA) methods in process improvement within healthcare organizations. By mapping, quantifying, and visualizing social relations, SNA can reveal inefficiencies in communication and coordination, which can then be targeted to develop interventions that enhance collaboration and improve patient outcomes.
Organizational structure: Leveraging SNA to enhance communication and coordination
SNA has proven invaluable in helping healthcare organizations better understand how their structures, such as management roles, task groupings, and geographical dispersion, influence communication and coordination. This insight can then inform opportunities for improvement.
For example, one study used SNA to improve the throughput of surgical patients in a post-anesthesia care unit (PACU). The analysis revealed a hierarchical network coordination structure where the charge nurse was a bottleneck, channeling all communication downstream. This led to a redesign of the organizational network to a more democratic structure where coordination was performed by an integrated IT system, reducing the dependence on the charge nurse and improving patient flow.
Another study used SNA within the Distributed Situation Awareness (DSA) framework to investigate system-wide communication in patient flow management. This helped identify bottlenecks and the roles most likely to experience communication or transaction overload while acquiring and disseminating situational awareness. The DSA model provided a blueprint for healthcare facilities to consider when modifying their organizational structure to improve communication and coordination.
The role of technology in supporting organizational communication and coordination
SNA has also been used to understand how information technology (IT) can enhance or transform organizational communication and coordination. Several studies have shown that IT can help improve communication efficiencies during in-person patient handoffs by removing redundant exchanges and supporting more emergent, non-linear information flow.
Additionally, electronic health record (EHR) data has been leveraged within SNA to map the network structure of professionals involved in care. This reveals how improving the design of IT systems can support more frequent information sharing among professional groups, leading to better communication and coordination.
Improving team performance through SNA
SNA has been instrumental in diagnosing the causes of poor team communication and coordination, which often stem from factors such as overburdened workloads, role conflicts, lack of leadership, and fragmented interprofessional relationships.
For example, SNA identified that the most efficient and effective healthcare teams focused more on internal team operations and used only one or two communication mediums (e.g., in-person, email) instead of dispersing time across multiple applications. Conversely, teams with too many connections (high degree of centrality) experienced interruptions and distractions, impacting their performance and coordination.
Furthermore, analyzing network cohesion can help identify fragmentation and cliques in the network, which may reflect a lack of collaboration and interprofessional relations. Denser communication networks with more clustering are associated with more rapid diffusion of information and stronger social support, reinforcing desired behaviors.
Identifying influential actors to drive process improvements
SNA has been used to identify influential actors who can act as brokers, opinion leaders, champions, or change agents to inform behavioral interventions and improve professional communication or coordination.
For instance, one study used SNA to identify influential physicians to join a quality improvement (QI) team. It found that having members with connections external to the team was most important for disseminating information, while within-team relationships mattered most for coordination, knowledge sharing, and communication.
Another study used SNA to identify and recruit champions who were then used to deploy a QI intervention (safe patient handling education program) to advance safety in critical access hospitals. This champion-centered approach resulted in improved safety outcomes after one year.
Opportunities for future research and practical applications
This review highlights the growing body of literature on the use of SNA methods to support process improvement in healthcare organizations. While past studies have primarily employed descriptive and cross-sectional designs, a small but increasing number of longitudinal and experimental studies demonstrate the value of SNA in identifying sources of variation and areas for improvement.
However, future research should aim to better leverage SNA theory to understand the reasons behind the structures of healthcare networks. Applying complexity science and network theory can help reconceptualize knowledge translation as an interdependent, relationship-centric process, supporting sustainable improvements.
Additionally, integrating SNA with emerging technologies, such as artificial intelligence and machine learning, presents an opportunity to unlock further insights from the large volumes of contact tracing and other healthcare data being collected.
From a practical standpoint, the network measures and graphical tools provided by SNA can complement existing contact tracing indicators, helping public health practitioners better comprehend and act upon the heterogeneity in disease transmission at the individual and community levels. Proactively identifying influential actors and closely connected patient groups can enable more targeted and effective contact tracing, monitoring, and interventions.
As healthcare organizations continue to grapple with the complexities of communication, coordination, and quality improvement, the insights gained through SNA will prove invaluable in designing and implementing sustainable process improvements that enhance patient safety and outcomes.
