Interorganizational Network Structures and Diffusion of Information Through a Health System

Gibbons, Deborah E.

doi:10.2105/ajph.2005.063669

Cited by 40 publications

(35 citation statements)

References 19 publications

(3 reference statements)

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“…This result is valuable because extant U.S.-centric research on interhospital patient transfer has argued that patient transfer decisions may be driven more by organizational concerns, bed availability, and established routines - and less by considerations of partner quality and capabilities. Despite the recent interest in the analysis of relational coordination between hospitals 8, xviii , to the best of our knowledge this is the first study of patient sharing relations based on newly derived relational event models that allow representing relations between hospitals in terms of sequences of individual patient sharing events.…”

Section: Discussionmentioning

confidence: 99%

Quality of Care and Interhospital Collaboration

Lomi¹,

Mascia²,

Vu³

et al. 2014

Medical Care

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Objectives We examine the dynamics of patient sharing relations within an Italian regional community of 35 hospitals serving approximately 1,300,000 people. We test whether interorganizational relations provide individual patients access to higher quality providers of care. Methods We reconstruct the complete temporal sequence of the 3461 consecutive interhospital patient sharing events observed between each pair of hospitals in the community during 2005-2008. We distinguish between transfers occurring between and within different medical specialties. We estimate newly derived models for relational event sequences that allow us to control for the most common forms of network-like dependencies that are known to characterize collaborative relations between hospitals. We use 45 day risk-adjusted readmission rate as a proxy for hospital quality. Results After controls (e.g., geographical distance, size, and the existence of prior collaborative relations), we find that patients flow from less to more capable hospitals. We show that this result holds for patient being shared both between as well as within medical specialties. Nonetheless there are strong and persistent other organizational and relational effects driving transfers. Conclusions Decentralized patient sharing decisions taken by the 35 hospitals give rise to a system of collaborative interorganizational arrangements that allow patient to access hospitals delivering a higher quality of care. This result is relevant for health care policy because it suggests that collaborative relations between hospitals may produce desirable outcomes both for individual patients, as well as for regional health-care systems.

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Section: Discussionmentioning

confidence: 99%

Quality of Care and Interhospital Collaboration

Lomi¹,

Mascia²,

Vu³

et al. 2014

Medical Care

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“…Network analyses are widely used in other areas, including sociology, (22) physics, (33) molecular biology, (33) management, (34) and military operations, (35,36) but only rarely in the study of health care systems. (37)(38)(39)(40) The existing transfer system is not a simple hierarchy. Small community hospitals do not exist as satellites of single local centers, which then refer to dominant regional centers.…”

Section: Discussionmentioning

confidence: 99%

The Structure of Critical Care Transfer Networks.

Iwashyna¹

2006

Critical Care Medicine

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Rationale-Moving patients from low performing hospitals to high performing hospitals may improve patient outcomes. These transfers may be particularly important in critical care, where small relative improvements can yield substantial absolute changes in survival.Objective-To characterize the existing critical care network in terms of the pattern of transfers.Methods-In a retrospective cohort study, the nationwide 2005 Medicare fee-for-service claims were used to identify the interhospital transfer of critically ill patients, defined as instances where patients used critical care services in 2 temporally adjacent hospitalizations.Measurements-We measured the characteristics of the interhospital transfer network and the extent to which ICU patients are referred towards each hospital in that network, a continuous quantitative measure at the hospital-level known as centrality. We evaluated associations between hospital centrality and organizational, medical, surgical and radiologic capabilities.Results-There were 47,820 transfers of critically ill patients among 3,308 hospitals. 4.5% of all critical care stays of any length involved an inter-hospital critical care transfer. Hospitals transferred out to a mean of 4.4 other hospitals. More central hospital position was associated with multiple indicators of increased capability. Hospital characteristics explained 40.7% of the variance in hospitals' centrality.Conclusions-Critical care transfers are common, and traverse an informal but structured network. The centrality of a hospital is associated with increased capability in delivery of services, suggesting that existing transfers generally direct patients toward better resourced hospitals. Studies of this network promise further improvements in patient outcomes and efficiency of care.Critical illness is a common and growing part of American medicine. (1) In this paper, we provide the first description of the informal system that has evolved for transferring critically ill Medicare beneficiaries among hospitals. Using nationwide data for 2005, we document the incidence of inter-hospital critical care transfers, and characterize the transfer network. In addition, we test two pre-specified hypotheses about the flow patients in the critical care network. "Centrality" is a hospital-level variable that quantifies the extent to which patients flow towards each hospital. (21) Most fundamentally, hospitals transfer more patients to central hospitals. We define centrality formally in the Methods. We hypothesized that observable hospital organizational characteristics and capabilities (organizational, medical, surgical, and radiologic capabilities) are associated with hospital centrality. Second, we hypothesized that the significant variation between hospitals' centrality in the network is associated with specified hospital characteristics. METHODS Analytic ApproachWe measured the interhospital transfer system using the tools of network analysis. Hospitals are the nodes in the network. Hospitals are connected by trans...

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“…Weak ties have been shown to facilitate the flow of information through networks [56]. They have been shown to improve performance when teams have a mix of strong and weak ties and their tasks are interdependent [57].…”

Section: Flows W: Weak Ties Access and Relational Qualitymentioning

confidence: 99%

The Communication and Social Network Flows Approach for Disruption Preparedness

Doerfel¹,

Harris²

2017

WIT Transactions on the Built Environment

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Resilience officers are an emerging profession who work on behalf of municipalities, cities, institutions, transportation hubs, businesses, etc. Their mission involves disaster preparedness, response, and management, in the hopes that their work minimizes the impacts of disruption. Their work is inherently communicative. Coordinating resilience involves local leaders, government agencies, response agencies and first responders, as well as the community's local groups, non-profits, and businesses. These organizations are connected in networks that are dynamic -partnerships are activated and go dormant, the nature of the relationships evolve (e.g., from cooperative to competitive, friendly to adversarial), the overall system varies in terms of overall activity (i.e., densely to barely connected), and leadership can vary from highly centralized around one or a few key organizations to decentralized with various clusters of partners. A common theoretical dilemma in social networks is that different network structures offer different advantages and disadvantages. The advantages and disadvantages are often in tension with each other and dependent on the situation. Yet building and maintaining relationships is crucial to the efficacy of resilience work. Moreover, these relationships exist within larger stakeholder networks comprised of organizations that are nested in their own set of networks, adding complexity to the challenges of such work. These theoretical dilemmas mean that practitioners need to be more nuanced in understanding organizations and ways to communicate to build social networks as part of preparing for the inevitable disruption. In this paper, we take a communication and social network theory perspective to propose a FLOWS approach to managing resilience. We draw on internal organizing forms (e.g., bureaucratic; networked), social capital, and stakeholder theory as concepts that pertain to communication and information technology use. Together, these theoretical frames point to the FLOWS approach to action-oriented resilience organizing.

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Interorganizational Network Structures and Diffusion of Information Through a Health System

Cited by 40 publications

References 19 publications

Quality of Care and Interhospital Collaboration

Quality of Care and Interhospital Collaboration

The Structure of Critical Care Transfer Networks.

The Communication and Social Network Flows Approach for Disruption Preparedness

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