Determinants of physician networks: an ethnographic study examining the processes that inform patterns of collaboration and referral decision-making among physicians

Abstract

ObjectiveMost scholarly attention to studying collaborative ties in physician networks has been devoted to quantitatively analysing large, complex datasets. While valuable, such studies can reduce the dynamic and contextual complexities of physician collaborations to numerical values. Qualitative research strategies can contribute to our understanding by addressing the gaps left by more quantitative approaches. This study seeks to contribute to the literature that applies network science approaches to the context of healthcare delivery. We use qualitative, observational and interview, methods to pursue an in-depth, micro-level approach to the deeply social and discursive processes that influence patterns of collaboration and referral decision-making in physician networks.DesignQualitative methodologies that paired ethnographic field observations, semistructured interviews and document analysis were used. An inductive thematic analysis approach was used to analyse, identify and describe patterns in those data.SettingThis study took place in a high-volume cardiovascular department at a major academic medical centre (AMC) located in the Midwest region of the USA.ParticipantsPurposive and snowballing sampling were used to recruit study participants for both the observational and face-to-face in-depth interview portions of the study. In total, 25 clinicians and 43 patients participated in this study.ResultsTwo primary thematic categories were identified: (1) circumstances for external engagement; and (2) clinical conditions for engagement. Thematic subcategories included community engagement, scientific engagement, reputational value, experiential information, professional identity, self-awareness of competence, multidisciplinary programmes and situational factors.ConclusionThis study adds new contextual knowledge about the mechanisms that characterise referral decision-making processes and how these impact the meaning of physician relationships, organisation of healthcare delivery and the knowledge and beliefs that physicians have about their colleagues. This study highlights the nuances that influence how new collaborative networks are formed and maintained by detailing how relationships among physicians develop and evolve over time.

Developing Implementation Strategies to Support the Uptake of a Risk Tool to Aid Physicians in the Clinical Management of Patients With Syncope: Systematic Theoretical and User-Centered Design Approach

“…This presents an opportunity to influence uptake through existing channels of social influence that extend beyond the primary setting of interest (in this case, the ED). Strategies may benefit from alignment with the underlying factors that influence patterns of collaboration, including perceived reputational value, experiential information (including personal relationships and visibility), professional identity, and self-awareness of competence [ 48 ]. In addition, strategies that target components such as champion or opinion leader, social support, and credible source would be promising ingredients to consider [ 27 ].…”

A Systematic Approach to Identifying and Developing Implementation Strategies to Support the Uptake of a Risk Tool to Aid in Clinical Management of Patients with Syncope: A Qualitative Study

“…Strategies may bene t from alignment with the underlying factors that in uence patterns of collaboration, including perceived reputational value, experiential information (including personal relationships and visibility), professional identity, and self-awareness of competence (50). In addition, strategies that target components such as champion/opinion leader, social support, and credible source would be promising ingredients to consider (51).…”

When Clinicians Group Together: A Systematic Scoping Review of Clustering in Patient-Sharing Networks

“…Some studies have shown that HCPs are more likely to refer patients to colleagues that they personally know (through common demographic backgrounds or education, [12] or common activities such as journal clubs, etc. [13]), are geographically closer (e.g., in the same building or area), [12] have facilitated communication means (e.g., through face to face communication or electronic health records), [13,14] share insurance plans, or are a liated with the same health systems. [12,15] Studying clusters of HCP networks is important to understand how healthcare is delivered and how healthcare systems can improve patient outcomes via changes in structures and processes.…”