Purpose: Teams are an integral component of quality improvement (QI) efforts in healthcare organizations. While the selection of team members may be critical to their success, there has been little research to guide selection of team members for QI teams. Our purpose was to use tools from social network analysis (SNA) to derive principles for the design of effective clinical QI teams. Specifically, network theory suggests that: 1) when innovation and information are critical to performance, team members should be chosen from different groups or clusters within an organization to increase access to non-redundant, diverse sources of expertise and information; 2) when coordination among team members is critical to performance, team members chosen with thought to connections among team members.
Method: To illustrate these principles, we used data on the social network of general medicine attending physicians at a large Midwestern medical center to model the structure of interaction among attending MDs at UCMC using Pajek, an open-source SNA package. To explore clustering of interaction among physicians along professional and sociodemographic characteristics to determine salient natural groupings characterizing the informal organization of physicians, we visually partitioned sociograms using data on MD gender, medical school graduating class (proxy for age group), time spent in primary care (30% or more), time spent in research (30% or more), subspecialty, and self-identification as a hospitalist. To enumerate theoretically optimal 2-person teams using information on patterns of social groupings and the connectedness of individuals, we calculated team net degree, defined as the sum of each member’s direct contacts, minus redundant contacts. Teams with the highest net degree were identified as “optimal.”
Result: Network partitions revealed striking tendency among these physicians towards differential association by subspecialty and hospitalist status, with less distinct clustering by gender and medical school class. In this network, optimal 2-person teams were comprised of individual members located in distant areas of the social space who bridged different social groups.
Conclusion: External connections of physicians within teams may be most important when QI projects require the collection of information or dissemination of influence, while the relationship of team members to each other may matter most when internal coordination, knowledge sharing, and communication are most important. Sociometric analyses of physician networks may improve the design of QI teams.
Candidate for the Lee B. Lusted Student Prize Competition