Claire Blacklock1, Amy Darwin2, Mike English1, Jacob McKnight1, Lisa Hinton3, Elinor Harriss4, Geoff Wong5. 1. Nuffield Department of Medicine, 6396University of Oxford, UK. 2. 8955Oxford Health NHS Foundation Trust, UK. 3. The Healthcare Improvement Studies Institute, 2152University of Cambridge, UK. 4. Bodleian Health Care Libraries, 6396University of Oxford, UK. 5. Nuffield Department of Primary Care Health Sciences, 6396University of Oxford, UK.
Abstract
OBJECTIVES: The social ties people have with one another are known to influence behaviour, and how information is accessed and interpreted. It is unclear, however, how the social networks that exist in multi-professional health care workplaces might be used to improve quality in hospitals. This paper develops explanatory theory using realist synthesis to illuminate the details and significance of the social ties between health care workers. Specifically we ask: How, why, for whom, to what extent and in what context, do the social ties of staff within a hospital influence quality of service delivery, including quality improvement? METHODS: From a total of 75 included documents identified through an extensive systematic literature search, data were extracted and analysed to identify emergent explanatory statements. RESULTS: The synthesis found that within the hospital workforce, an individual's place in the social whole can be understood across four identified domains: (1) social group, (2) hierarchy, (3) bridging distance and (4) discourse. Thirty-five context-mechanism-outcome configurations were developed across these domains. CONCLUSIONS: The relative position of individual health care workers within the overall social network in hospitals is associated with influence and agency. As such, power to bring about change is inequitably and socially situated, and subject to specific contexts. The findings of this realist synthesis offer a lens through which to understand social ties in hospitals. The findings can help identify possible strategies for intervention to improve communication and distribution of power, for individual, team and wider multi-professional behavioural change in hospitals.
OBJECTIVES: The social ties people have with one another are known to influence behaviour, and how information is accessed and interpreted. It is unclear, however, how the social networks that exist in multi-professional health care workplaces might be used to improve quality in hospitals. This paper develops explanatory theory using realist synthesis to illuminate the details and significance of the social ties between health care workers. Specifically we ask: How, why, for whom, to what extent and in what context, do the social ties of staff within a hospital influence quality of service delivery, including quality improvement? METHODS: From a total of 75 included documents identified through an extensive systematic literature search, data were extracted and analysed to identify emergent explanatory statements. RESULTS: The synthesis found that within the hospital workforce, an individual's place in the social whole can be understood across four identified domains: (1) social group, (2) hierarchy, (3) bridging distance and (4) discourse. Thirty-five context-mechanism-outcome configurations were developed across these domains. CONCLUSIONS: The relative position of individual health care workers within the overall social network in hospitals is associated with influence and agency. As such, power to bring about change is inequitably and socially situated, and subject to specific contexts. The findings of this realist synthesis offer a lens through which to understand social ties in hospitals. The findings can help identify possible strategies for intervention to improve communication and distribution of power, for individual, team and wider multi-professional behavioural change in hospitals.
Authors: Trisha Greenhalgh; Joseph Wherton; Chrysanthi Papoutsi; Jennifer Lynch; Gemma Hughes; Christine A'Court; Susan Hinder; Nick Fahy; Rob Procter; Sara Shaw Journal: J Med Internet Res Date: 2017-11-01 Impact factor: 5.428