Role network measures to assess healthcare team adaptation to complex situations: the case of venous thromboembolism prophylaxis.

Salwei ME1,2, Carayon P1,2, Hundt AS2, Hoonakker P2, Agrawal V3, Kleinschmidt P4, Stamm J3, Wiegmann D1,2, Patterson BW2,4.

Author information

1: a Department of Industrial and Systems Engineering , University of Wisconsin-Madison , Madison , Wisconsin , USA.
2: b Center for Quality and Productivity Improvement , University of Wisconsin-Madison , Madison , Wisconsin , USA.
3: c Geisinger Health System , Danville , Virginia , USA.
4: d School of Medicine and Public Health , University of Wisconsin-Madison , Madison , Wisconsin , USA.

Abstract

Hospitals are complex environments that rely on clinicians working together to provide appropriate care to patients. These clinical teams adapt their interactions to meet changing situational needs. Venous thromboembolism (VTE) prophylaxis is a complex process that occurs throughout a patient's hospitalisation, presenting five stages with different levels of complexity: admission, interruption, re-initiation, initiation, and transfer. The objective of our study is to understand how the VTE prophylaxis team adapts as the complexity in the process changes; we do this by using social network analysis (SNA) measures. We interviewed 45 clinicians representing 9 different cases, creating 43 role networks. The role networks were analysed using SNA measures to understand team changes between low and high complexity stages. When comparing low and high complexity stages, we found two team adaptation mechanisms: (1) relative increase in the number of people, team activities, and interactions within the team, or (2) relative increase in discussion among the team, reflected by an increase in reciprocity. Practitioner Summary: The reason for this study was to quantify team adaptation to complexity in a process using social network analysis (SNA). The VTE prophylaxis team adapted to complexity by two different mechanisms, by increasing the roles, activities, and interactions among the team or by increasing the two-way communication and discussion throughout the team. We demonstrated the ability for SNA to identify adaptation within a team.