Social Networks Methods in Health Services Research
advertisement
Social Networks Methods in Health
Services Research
Presentation Organization
An Introduction to Social Networks
Methods in Health Services Research
AcademyHealth Annual Meetings, 2007
Introduction to social networks
methods
Three examples of social networks
research in health services research
Doug Wholey
Health Policy & Management, School of Public Health, University of Minnesota
David Krackhardt
The H. John Heinz III School of Public Policy and Management, Carnegie Mellon
University
6/4/2007
Social Networks Methods in Health Services Research
1
6/4/2007
Presenters
Professor, Division of Health Policy &
Management, School of Public Health,
University of Minnesota
David Krackhardt
{
{
2007 Summer Institute, June 25 - July 1, 2007
Social Networks Methods in Health Services Research
3
Introduction to Social Networks
Methods
6/4/2007
Social Networks Methods in Health Services Research
Wholey & Krackhardt, AcademyHealth,
2007
Social Networks Methods in Health Services Research
4
Examples of Social Network Studies in
Health Services Research
David Krackhardt
6/4/2007
Social Networks Resources
Life in the Pentagon
Presentation
Professor of Organizations at the Heinz School
of Public Policy and Management and the
Tepper School of Business, Carnegie Mellon
University
Center for Computational Analysis of Social and
Organizational Systems (CASOS)
6/4/2007
2
Handouts
Doug Wholey
{
Social Networks Methods in Health Services Research
Doug Wholey
5
6/4/2007
Social Networks Methods in Health Services Research
6
1
Social Networks Methods in Health
Services Research
Issues in Studying Networks:
Identifying Network Boundaries
Examples
{
{
{
{
Collaborators: David Knoke, Bill Riley, and Amy
Wilson
6/4/2007
Social Networks Methods in Health Services Research
7
Issues in Studying Networks: Which
Relationships?
{
{
{
Social Networks Methods in Health Services Research
{
{
9
1
0
0
1
1
0
1
1
0
AxA’ (Common Attendance) =
Use UCINET’s /Data/Affiliations tool
6/4/2007
N (actor) x A (attribute)
Can use to construct a relational matrix showing similarity
between two actors (same gender, difference in age)
6/4/2007
N (actor) x A (event) matrix
Can use to construct a relational matrix to who who
attends the same meetings
Social Networks Methods in Health Services Research
10
The Minnesota Cancer Alliance
Attended Meeting
1
2
3
4
0
1
1
N (actor) x N (actor) matrix
Who interacts with who?
Event/Affiliation data
{
Issues in Studying Networks: Event
Data to Relational Data
George
Sam
Jane
8
Attribute data
{
Who do you share information with about
program development?
Who do you work with to develop
programs?
Who are you collaborating with to obtain
funding for programs?
6/4/2007
Social Networks Methods in Health Services Research
Relational data
{
Collaboration
Levels of collaboration
{
6/4/2007
Network membership is defined by research interests
Agencies serving people in prostitution agencies
Public health systems – organizations providing public
health related services in a geographic area
Issues in Studying Networks:
Relational, Attribute, & Event Data
Types of relations
{
Network exists as a social object, there is a defined
boundary and membership, there is shared knowledge
Minnesota Cancer Alliance, medical groups, associations,
rural health networks, assertive community treatment
teams
Nominalist
{
Collaborator: Kate Downing, MPH candidate
Teams and sub-teams in medical practice
{
Realist
{
Collaborator: Michael Pfeffer, MPH candidate
Evaluating an intervention to coordinate
agencies providing services to people in
prostitution in North Minneapolis
{
Evaluating the Minnesota Cancer Alliance
= A (Event Matrix)
A coalition of health care organizations
founded in 2005 with the goals of
{
{
G
2
S
2
J
0
{
George
Sam
Jane
2
0
3
1
1
1
{
Social Networks Methods in Health Services Research
Wholey & Krackhardt, AcademyHealth,
2007
11
{
6/4/2007
Reducing disparities in cancer screening and
treatment
Improving access to information about locallyavailable services for cancer patients and their
families
Increasing colorectal cancer screening
Increasing the tobacco excise tax and
expanding clean indoor air
http://www.cancerplanmn.org/The_Minnesota_C
ancer_Alliance.html
Social Networks Methods in Health Services Research
12
2
Social Networks Methods in Health
Services Research
Comprehensive Cancer Control
Collaborative
Alliance Evaluation and Committees
For cancer prevention and treatment in a
community,
Develop a shared comprehensive vision
{
Eliminate duplications, integrate efforts, reduce
organizational and programmatic fragmentation
{
Plan and implement an evidence based program
{
Identify gaps and prioritize action
{
Reallocate resources
{
Advocate with one voice
{
“Increased coordination of partner activities and enhanced
collaboration” (6).
Leslie S. Given, Bruce Black, Garry Lowry, Philip Huang, &
Jon F. Kerner, 2005, Collaborating to conquer cancer: A
comprehensive approach to cancer control, Cancer Causes
and Control 16(Suppl): 3-14.
{
6/4/2007
Social Networks Methods in Health Services Research
13
{
{
People
Organizations
How does participation
evolve?
Who is central in each
committee?
Who is central across
committees?
What is the structure of
interaction
{
6/4/2007
Structure = repeated
patterns of interaction
Committees
Community Health Worker
Cervical Cancer Screening
Colorectal Cancer
Screening
Access to Information
Health Disparities
Steering Committee
Evaluation Committee
Communications
Committee
Finance Committee
Membership Committee
Social Networks Methods in Health Services Research
14
Data Source: Meeting Archives
{
{
Evaluation
Who is active where?
Health Disparities Committee
(Three or More Meetings)
Methods
Meeting Attendance
Individual - Organizational
Methods:
{
{
6/4/2007
Used UCINET to translate affiliation data
(copmmon meetings attended) to relational data
Number of meetings attended by both members
of a dyad is strength of attachment to committee
Social Networks Methods in Health Services Research
15
Health Disparities Committee
(Four or More Meetings)
6/4/2007
Social Networks Methods in Health Services Research
Wholey & Krackhardt, AcademyHealth,
2007
6/4/2007
Social Networks Methods in Health Services Research
16
Health Disparities Committee
(Four or More Meetings)
17
6/4/2007
Social Networks Methods in Health Services Research
18
3
Social Networks Methods in Health
Services Research
Colorectal Cancer Committee
(1 or More Meetings)
6/4/2007
Social Networks Methods in Health Services Research
Colorectal Cancer Committee
(6 or More Meetings)
19
Colorectal Cancer Committee
(14 or More Meetings)
6/4/2007
Social Networks Methods in Health Services Research
20
Further Analyses: Which actors are
central across committees?
…
Disparities
Access to Information
Cervical
Colorectal
6/4/2007
Social Networks Methods in Health Services Research
21
What Can We Learn from Meeting
Attendance
{
Are there core and peripheral members?
How stable are relationships?
Which actors coordinate/bridge across
committees?
Social Networks Methods in Health Services Research
Wholey & Krackhardt, AcademyHealth,
2007
22
Initial analyses took advantage of
unobtrusive measures: Meeting attendance
Why are some members more involved than
others in a committee?
{
23
What is the content of the relationship?
Watching? Collaborating?
Research to develop a better understanding
of committees and involvement
Develop a survey to understand
involvement and describe networks better
{
6/4/2007
Social Networks Methods in Health Services Research
Next Steps
Which members within the committee?
{
6/4/2007
6/4/2007
Field experience by Michael Pfeffer
Social Networks Methods in Health Services Research
24
4
Social Networks Methods in Health
Services Research
Improving Service Delivery for People
in Prostitution
The Problem – North Minneapolis and
Prostitution
Research and Intervention led by
Folwell Center for Urban Initiatives
North Minneapolis, MN
Lauren Martin, Ph.D.
Kate Downing, MPH Candidate
{
{
{
Poverty
Population of Color
Mental Health and Substance Abuse
A doubly stigmatized, vulnerable
population
Project Focus Area, North Minneapolis
6/4/2007
Social Networks Methods in Health Services Research
25
The Problem: Service Delivery
{
Few prostitution specific services
Politics of Delivery
{
Ideological Barriers
Funding Scarcity
Social Networks Methods in Health Services Research
{
{
27
{
6/4/2007
{
Do you go to the same meetings?
Do you collaborate on programs?
Do you go after funding together?
{
{
{
Social Networks Methods in Health Services Research
Wholey & Krackhardt, AcademyHealth,
2007
28
29
For service providers to work together
For women involved in prostitution to find safety,
community and services
The space will offer:
{
6/4/2007
Social Networks Methods in Health Services Research
A point of connection:
{
What does it mean to ‘work with?’
Asking probing questions:
Funding search in progress for intervention
and evaluation
The Intervention:
Northside Women’s Space
What does Collaboration really mean?
{
Understanding the mechanism
Pre-Post Evaluation
The Evaluation
26
Evaluate an intervention to coordinate
agencies
Network Analysis
A difficult context to organize
6/4/2007
Social Networks Methods in Health Services Research
The Evaluation
Access to Services
{
6/4/2007
6/4/2007
Resource guide
Non-judgmental referral services
Workshops
Safe sex supplies, snacks, etc.
Social Networks Methods in Health Services Research
30
5
Social Networks Methods in Health
Services Research
The Intervention:
Northside Women’s Space
One central actor managing the space
{
{
Folwell Center for Urban Initiatives
Kate Downing
Support development and research
Challenges
Other agencies will staff the space
{
Adhering to soon available best practices
{
6/4/2007
Social Networks Methods in Health Services Research
31
Expected Outcome:
Northside Women’s Space
More network ties
Central node for
the Northside
{
{
Care integration
Improved quality of
care and service
Improved
outcomes
6/4/2007
{
{
{
6/4/2007
The Context & Argument
Greater visibility of the
problem
Improvement in
service delivery
Continuing needs
assessment
Advocacy for change
through collaboration
Shift from crisis
oriented care to primary
prevention
Social Networks Methods in Health Services Research
33
32
Social Networks Methods in Health Services Research
Wholey & Krackhardt, AcademyHealth,
2007
The Mechanism
Care teams
{
Interdisciplinary teams
serving a population
{
Task work (service provision)
coordinated with team work
(systems, coordinating
service delivery)
Hope
{
Integrated care
{
Greater productivity through
reduced waste (lean
management, QI)
{
Better patient outcomes
{
Better team member
outcomes
Social Networks Methods in Health Services Research
34
Teams
Chronic Care Teams
http://www.improvingchroniccare.org /
Assertive Community Treatment (ACT)
Teams
(http://www.actassociation.org/actModel/ )
Prepared Practice Teams
(http://www.ihi.org/IHI/Topics/ChronicConditi
ons/AllConditions/ImprovementStories/Purs
uingPerfectionReportfromHealthPartnerson
PreparedPracticeTeams.htm)
Medical Homes and Patient Homes
6/4/2007
Health care is becoming more
differentiated
{
New technologies and
technicians
{
Professional jurisdictions
shifts
Care is shifting towards chronic
rather than acute conditions
Chronic conditions require
integration of a large variety of
services: Social, mental, and
medical services
Lack of care integration results in
inadequate care for individuals
with chronic conditions
6/4/2007
Social Networks Methods in Health Services Research
Care Teams in Medical Practice
Care Team Examples
A barrier to political will, funding
Identifying agencies to survey
Success means:
Women’s Space
The questions we can’t ask…
Maintaining neutrality and building
bridges
Developing trust and keeping it
Unknown, invisible population size
35
“A team can be defined as
{
{
{
{
{
{
{
(a) two or more individuals who
(b) socially interact (face-to-face or, increasingly, virtually);
(c) possess one or more common goals;
(d) are brought together to perform organizationally relevant
tasks;
(e) exhibit interdependencies with respect to workflow, goals,
and outcomes;
(f) have different roles and responsibilities; and
(g) are together embedded in an encompassing organizational
system, with boundaries and linkages to the broader system
context and task environment.”
Steve W. J. Kozlowski and Daniel R. Ilgen. 2006. "Enhancing
the Effectiveness of Work Groups and Teams." Psychological
Science in the Public Interest 7:77-124 (79).
6/4/2007
Social Networks Methods in Health Services Research
36
6
Social Networks Methods in Health
Services Research
Issues in Identifying Care Teams
Boundary specification – who is a team
member?
{
{
{
Nominalist
(Researcher
Defined)
Social Networks Methods in Health Services Research
37
6/4/2007
Using Interdependence to Identify
Teams
{
{
Social Networks Methods in Health Services Research
MD25
MD54
MD64
MD82
N00
N08
N21
N25
N54
N71
N79
0
0
0
0
0
3
1
2
2
3
0
3
{
6/4/2007
0
2
0
0
2
3
2
2
3
3
0
3
2
2
0
0
0
3
3
1
2
3
3
0
3
2
1
3
0
0
0
0
0
0
0
0
0
0
0
3
2
0
2
2
0
2
2
0
2
3
0
0
0
2
2
1
2
2
0
2
2
2
N00
3
3
3
1
3
2
0
1
1
1
3
2
2
N08
1
2
1
3
2
2
1
0
2
2
2
2
2
1
N21
2
2
2
0
0
1
1
2
0
1
2
1
1
1
N25
2
3
3
0
2
2
1
2
1
0
2
1
2
1
3
3
3
0
2
2
3
2
2
2
0
3
2
2
N71
0
0
0
0
0
0
2
2
1
1
3
0
3
2
N79
3
3
3
0
2
2
2
2
1
2
2
3
0
2
2
2
2
1
2
2
2
1
1
1
2
2
2
N82
6/4/2007
40
1
MD64
MD82
N54
Social Networks Methods in Health Services Research
2
0
0
0
(c) possess one or more common goals;
(d) are brought together to perform organizationally relevant tasks;
N82
MD21
0
Informal consulting
Inferred
{
MD25
0
Occupational heterogeneity
Graphing the Full Sociomatrix:
Pediatrics Clinic
MD21
0
Dense interdependence
(b) socially interact (face-to-face or, increasingly, virtually)
{
At least two actors
(f) have different roles and responsibilities;
{
Groups based on structurally equivalence: “Two nodes are said to be exactly
structurally equivalent if they have the same relationships to all other nodes.”
(e) exhibit interdependencies with respect to workflow, goals, and outcomes;
{
39
0
0
38
(a) two or more individuals who
MD08
0
Social Networks Methods in Health Services Research
A Work With Sociomatrix:
Pediatrics Clinic
MD54
Groups of
interdependent
actors
(g) are together embedded in an encompassing organizational system, with
boundaries and linkages to the broader system context and task environment.
{
Work with means that you and the other person are interdependent
during work – your actions affect each other directly. It does not refer to
the situation where you and the other person contribute separately to
clinic performance while you work in the same location. Please answer
these questions for all others with whom you work (e.g., physicians,
rooming nurses, staff, laboratory technicians, and receptionists).
Patient care means all direct patient care and patient care related
activities (e.g., ordering tests, calling in prescriptions, talking with patients
on phone).
6/4/2007
MD08
Top
management
teams, Clinics
{
Tim Carroll and Richard M. Burton. 2001. "Organizations and
Complexity: Searching for the Edge of Chaos." Computational &
Mathematical Organization Theory 6:319-337.
David Krackhardt, 1994, "Constraints on the Interactive Organization as
an Ideal Type." In Charles Heckscher & Anne Donnellan (eds.), The
Post-Bureaucratic Organization. Beverly Hills, CA: Sage, p. 211-222.
Who do you work with to provide patient care?
{
Team
membership
perceptions
Identifying Teams Using Structural
Equivalence
Organizational theory and complexity theory: “Organizing at the edge
of chaos”
{
ACT teams
(Social Fact)
Emergent teams
Inertial teams
6/4/2007
Individual
Realist
Assertive Community Treatment & Individual
Treatment Teams
Football teams
Formal and informal teams
{
Structural
Floaters? Visiting consultants? Anyone who has
anything do do with care delivery?
Teams and sub-teams
{
Identifying Teams and Sub-teams
Social Networks Methods in Health Services Research
Wholey & Krackhardt, AcademyHealth,
2007
0
41
6/4/2007
Social Networks Methods in Health Services Research
42
7
Social Networks Methods in Health
Services Research
Structurally Equivalent Actors:
Pediatrics Clinic
Occupational
Grouping
Graphing the Full Sociomatrix:
Family Practice Clinic
2N
6 MDs, 1 N
4N
1N
6/4/2007
Social Networks Methods in Health Services Research
43
Structurally Equivalent Actors:
Family Practice Clinic
6/4/2007
2 MD, 1 ST
Teams
Informal consulting
{
2 MD, 5 N
{
4 ST
{
2 MD, 1 N,
2 ST, 1 T
N, 3 ST, T
Social Networks Methods in Health Services Research
45
Where are sub-teams in
6/4/2007
Chronic care teams?
Primary care practices?
Assertive community treatment teams?
How are sub-teams connected?
{
{
6/4/2007
Wholey & Krackhardt, AcademyHealth,
2007
Social Networks Methods in Health Services Research
46
Observing relations rather than actors
Defining network boundaries
Defining relations to measure
{
Is it too many? Process loss and
perturbations?
Is it too few? So loosely coupled system
is not integrated.
Social Networks Methods in Health Services Research
Organizing at the edge of chaos
Social Networks Research Challenges
(And Benefits)
Usefulness of Methodology
Pediatrics – pool staffing
Family practice – practice teams
Consistent with organizational and
complexity theory
{
2 ST
is more likely to occur within teams than
between teams
Is greater in more cross-functional and
interdependent teams
Teams consistent with clinic staffing rules
{
44
Predictive Validity for Interdependence
Method for Identifying Teams
2 MD, 2 N
6/4/2007
Social Networks Methods in Health Services Research
{
47
Friendship? Respect? Work-with?
Helping?
Level of detail
Obtaining high response rates
6/4/2007
Social Networks Methods in Health Services Research
48
8
Social Networks Methods in Health
Services Research
Managerial Benefits of a Social
Network Approach
Managing relations is a key function of
management
Relations can be managed with relatively
simple interventions (staffing)
{
Research Benefits of a Network
Approach
Measuring networks supports
{
6/4/2007
{
Accurate understanding of network
structure, which supports effective
management
Social Networks Methods in Health Services Research
Wholey & Krackhardt, AcademyHealth,
2007
Evaluate interventions designed to
integrate care
Understand the black box between
formal and informal structure
{
{
49
6/4/2007
Paths (or lack of paths) for information
flow
Disconnects
Too many connections
Social Networks Methods in Health Services Research
50
9
