Measuring the Value of a Health System Using Social Network Analysis
The Dartmouth College Center of Excellence defines a health system as an organization that consists of either at least one hospital plus at least one group of physicians. It is not uncommon for health systems to include more than one hospital and ambulatory venues.
According to Becker’s Hospital Review, “systemness” is a “term increasingly used to describe the desired future state of complex healthcare delivery systems – delivering patient-focused, seamless and high-quality care across the many parts of the system to maximize value for customers.” This new frontier of healthcare, as Becker’s calls it, is meant to create a well-integrated and rationally configured system that will continually provide value to the customer or patient.
David Willis’ recent report provides a framework for understanding value that can be created by a system. Operational and clinical standardization of processes and practices, as well as economies of scale and an increase in access points are its most basic values. Even greater benefit is derived from true system integration and rationalization, so that a system as a whole, not just the sum of its parts, can be leveraged to improve and transform care.
One example is the consolidation of high cost complex services from across the system into one location, improved by efforts to make that service accessible from any access point/venue of care within the system. Another marker of higher-level integration is the ease with which patients can move across different venues of care over the course of a single episode of illness, i.e., from ambulatory care to post-acute care.
The challenge for health systems is not only to strive to create a system operating at the higher levels of value but also to be able to measure the degree to which the system is able to achieve structural and transformational advantages. As a health care executive and social network researcher, I suggest that social network analysis may be a useful tool to measure system-ness.
Social network analysis (SNA) is primarily focused on describing and analyzing the properties of a network of interconnected nodes (e.g., venues of care) to find properties of the network that emerge from the structure and content when looked at in the aggregate and not just as the sum of the individual parts. Whereas traditional metrics of a system may focus on number of encounters, patient service revenue, costs per unit of service, number of adverse medical incidents and patient experience, SNA can look at cohesion of system, geographic density of services, connectivity of the system and nature of the path from one venue of care to another. Not only does the SNA provide a new window on system-ness, once the network is described using SNA, then you can also correlate those findings with patient experience and outcomes as well as costs and revenues.
SNA can be especially useful as systems focus on population health. In this context, population health refers to efforts to support the wellness and treat illnesses in a group of people--patients and non-patients, for whom the system is financially accountable. To this end, it might be helpful, for example, to compare the network characteristics of the health system as designed by its leaders to the network characteristics of how the population actually utilizes care. This process evaluation may be useful to help systems understand where potential value of the system is getting lost.
Researchers and practitioners have suggested using social networks, including social media networks, to diffuse information and innovations to patients and practitioners, possibly even creating behavioral change. They have also described the importance of social networks as facilitators or inhibitors of care use. Certainly, SNA is a great tool to study and leverage social networks.
But, I wonder whether we are neglecting a useful method that could be used to measure systemness and the value it brings?