Networks and Communications

The nature and quality of webs of social networks and the nature and quality of formal and informal communications within an organization.  

Research on organizational change has moved beyond reductionist measures of organizational structure, and increasingly embraces the complex role that networks and communications have on implementation of change interventions [1]. Connections between individuals, units, services, and hierarchies may be strong or weak, formal or informal, tangible or intangible. Social capital describes the quality and the extent of relationships and includes dimensions of shared vision and information sharing. One component of social capital is the internal bonding of individuals within the same organization [2]. Complexity theory posits that relationships between individuals may be more important than individual attributes [3], and building these relationships can positively influence implementation [4]. These relationships may manifest to build a sense of ‘teamness’ or ‘community’ that may contribute to implementation effectiveness [5]. In addition, the more stable teams are (members are able to be with the team for an adequate period of time; low turnover), the more likely implementation will be successful [5].

Regardless of how an organization is structurally organized, the importance of communication across the organization is clear. Communication failures are involved with the majority of sentinel events in US hospitals [6]. High quality of formal communications contributes to effective implementation [7]. Making staff feel welcome (good assimilation), peer collaboration and open feedback and review among peers and across hierarchical levels, clear communication of mission and goals (see Goals and Feedback), and cohesion between staff and informal communication quality, all contribute to effective implementation [7].

The Network and Communications construct in the CFIR consolidates several domains from Greenhalgh, et al. including organizational structure, intraorganizational communication, and intraorganizational networks [2]. Little is known about the interplay between formal structure, informal networks, and effective communication. Thus, we consolidate these concepts into a single construct to give wide latitude for researchers to take deductive approaches to explore alternate theories such as social networking [8] or complexity [1][9] theories. This construct, perhaps more than any other, requires a more grounded approach of study; leaning toward a constructivist approach for analysis [10] until we understand more about the role of networks and communications and especially how it interrelates with other constructs. Greenhalgh et al. cite strong or moderate influence of intraorganizational communication, intraorganizational networks, internal boundary spanning, and organizational structure on implementation [2]. Coordination across departments and specialties is essential for effective implementation to attenuate the “complex web of sources of power and covert and overt sources of influence” that all contribute to individual decisions about whether to cooperate [11, page 233]. A core principle of complexity theories leads to the idea that the actions of individuals and units affect implementation, positively or negatively, in predicted and unpredictable ways [12]. Integration to bridge traditional intra-organizational boundaries among individual components is one of five critical elements for driving transformation in patient care [13]. Connections between individuals, units, services, hierarchies may be strong or weak, formal or informal, visible or invisible. Physicians and nurses may struggle with routine (and role) changes that require coordination of activities and sharing of information across professions or units [14]. Clear role definitions (e.g., physician and non-physician roles) positively influences implementation [15][16]. The PARHiS model asserts that clearly defined physical, social, cultural, structural, and system boundaries contributes to research uptake [17][18]. Teamwork is emphasized as an essential “core property” for successful implementation of quality improvement initiatives [19, page 287]. Relationships with others, teamwork, and power and authority structures are all part of network and communications and influence implementation [17][18].

Strong horizontal and informal networks have positive relationship with adoption; e.g., physicians are influenced by the spreading of information through peers [2]. Strong intra-organizational communications are positively associated with implementation as is devolving decision-making to the front-line teams or individuals [2][20]. Strong communication includes having access to information (see Access to Knowledge and Information), being well-informed, and understanding the goals related to an intervention and all contribute to successful implementation [21]. Vertical and formal networks can also have a positive relationship with implementation; e.g., nurses may be most influenced by authoritative decisions [2].

Inclusion Criteria

Include statements about general networking, communication, and relationships in the organization, such as descriptions of meetings, email groups, or other methods of keeping people connected and informed, and statements related to team formation, quality, and functioning.

  • “We worked with prosthetics and physical therapy to get this going.”
  • “The people in prosthetics wouldn’t order the supplies we needed…they care more about rules than helping patients.”
  • “I have a great relationship with my boss…she supports me in getting this by asking me status and we have regular meetings.” Note: May double-code this with Leadership Engagement
  • “If I want to get something done, informal communications work the best. I just email or pick up the phone.”
  • “I wouldn’t go through formal communications to get anything done, that just takes too much documentation and nothing gets done… it’s better to stay under the radar.”
  • “We hardly knew each other in the beginning but now we are a real team – we even go out to dinner sometimes.”

Exclusion Criteria

Exclude statements related to implementation leaders’ and users’ access to knowledge and information regarding using the program, i.e. training on the mechanics of the program and code to Access to Knowledge & Information.

Exclude statements related to engagement strategies and outcomes, e.g., how key stakeholders became engaged with the innovation and what their role is in implementation, and code to Engaging: Key Stakeholders.

Exclude descriptions of outside group memberships and networking done outside the organization and code to Cosmopolitanism.

Check out SIRC’s Instrument Review project and published systematic review protocol, which has cataloged over 400 implementation-related measures. 

Note: As we become aware of measures, we will post them here. Please contact us with updates.

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  2. Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O: Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q 2004, 82:581-629.
  3. Plsek PE, Wilson T: Complexity, leadership, and management in healthcare organisations. BMJ 2001, 323:746-749.
  4. Safran DG, Miller W, Beckman H: Organizational dimensions of relationship-centered care. Theory, evidence, and practice. J Gen Intern Med 2006, 21(Suppl 1):S9-15.
  5. Edmondson AC, Bohmer RM, Pisana GP: Disrupted routines: Team learning and new technology implementation in hospitals. Adm Sci Q 2001, 46:685-716.
  6. Pronovost PJ, Berenholtz SM, Goeschel CA, Needham DM, Sexton JB, Thompson DA, Lubomski LH, Marsteller JA, Makary MA, Hunt E: Creating high reliability in health care organizations. Health Serv Res2006, 41:1599-1617.
  7. Simpson DD, Dansereau DF: Assessing Organizational Functioning as a Step Toward Innovation. NIDA Science & Practice Perspectives 2007, 3:20-28.
  8. Scott J: Social Network Analysis: A Handbook. 2nd edn. London, UK: Sage Publications; 2000.
  9. Burnes B: Complexity theories and organizational change. International Journal of Management Reviews 2005, 7:73-90.
  10. Lincoln YS, Guba EG: Paradigmatic controversies, contradictions, and emerging confluences. In The Landscape of Qualitative Research: Theories and Issues. 2nd edition. Edited by Denzin NK, Lincoln YS. Thousand Oaks, CA: Sage Publications; 2003: 253-291.
  11. Feldstein AC, Glasgow RE: A practical, robust implementation and sustainability model (PRISM) for integrating research findings into practice. Jt Comm J Qual Patient Saf 2008, 34:228-243.
  12. Fitzgerald LA: Chaos: the lens that transcends. Journal of Organizational Change Management 2002, 15:339-358.
  13. VanDeusen Lukas CV, Holmes SK, Cohen AB, Restuccia J, Cramer IE, Shwartz M, Charns MP: Transformational change in health care systems: An organizational model. Health Care Manage Rev 2007, 32:309-320.
  14. Klein KJ, Conn AB, Sorra JS: Implementing computerized technology: An organizational analysis. J Appl Psychol 2001, 86:811-824.
  15. Bodenheimer T, Wagner EH, Grumbach K: Improving primary care for patients with chronic illness: the chronic care model, Part 2. JAMA 2002, 288:1909-1914.
  16. Bodenheimer T, Wagner EH, Grumbach K: Improving primary care for patients with chronic illness. JAMA 2002, 288:1775-1779.
  17. Kitson A, Harvey G, McCormack B: Enabling the implementation of evidence based practice: a conceptual framework. Qual Health Care 1998, 7:149-158.
  18. Rycroft-Malone J, A., Kitson G, Harvey B, McCormack K, Seers AT, Estabrooks C: Ingredients for change: revisiting a conceptual framework. (Viewpoint). Quality and Safety in Health Care 2002, 11:174-180.
  19. Ferlie EB, Shortell SM: Improving the quality of health care in the United Kingdom and the United States: a framework for change. Milbank Q 2001, 79:281-315.
  20. Meyers PW, Sivakumar K, Nakata C: Implementation of Industrial Process Innovations: Factors, Effects, and Marketing Implications. Journal of Product Innovation Management 1999, 16:295-311.
  21. Helfrich CD, Weiner BJ, McKinney MM, Minasian L: Determinants of implementation effectiveness: adapting a framework for complex innovations. Med Care Res Rev 2007, 64:279-303.