Medical Decision-Making and Network Assembly Mechanisms in Inpatient Surgical Care

住院手术护理在很大程度上依赖于团队合作。一名患者将在术前和术后护理过程中看许多医生和其他护理提供者。手术本身还涉及多名外科医生和其他护理人员。随着医生在外科护理过程中共同努力，发展起来的关系创建了对护理质量和效率具有重要影响的团队合作网络。这项研究将观察和采访医生、护士和其他护理人员关于他们的工作和他们在住院手术过程中所做的治疗决定。这些信息将被用来系统地检查协作网络如何在医院中发展和变化。这项研究将为提高手术护理的质量和降低手术护理成本的努力提供信息，同时为有关此类网络如何形成和增长的重要社会科学问题提供新的见解。在过去的二十年中，随着新的数据和方法使转向动态分析成为可能，关于网络的社会科学研究经历了戏剧性的变化。同时，组织理论、经济和文化社会学领域的工作强调关系、结构及其影响的偶然性和情境性。虽然各种类型的网络已被证明可在广泛的实质性领域影响个人和集体成果，但微观网络动态、宏观网络结构及其影响之间的联系尚未得到充分说明。这项研究将采取重要步骤，通过研究组织安排、个人选择和现有关系如何影响医生的治疗决策，并最终影响个别医院和更广泛的医疗市场中更大患者群体的健康，来解释这类具有实质性意义的网络的形成和影响。这种基于机制的方法来理解医生关系如何在特定的组织和治疗情况下形成、复制和变化，将大规模网络的集体动态方面的工作与强调关系产生、获得意义和发挥其影响的组织和制度背景的理论结合在一起。我们在这里提出的理论锚定的、观察性的和基于访谈的实地工作试图澄清网络演变的复杂过程，同时确定跨越个人偏好、结构压力和组织限制或机会的特定机制、范围条件和意外情况。

Inpatient surgical care largely relies on teamwork. A single patient will see many doctors and other care providers over the course of pre- and postoperative care. The surgery itself also involves multiple surgeons and other caregivers. The relationships that develop as physicians work together during the surgical care process create teamwork networks that have important implications for the quality and efficiency of care. This research will observe and interview physicians, nurses, and other caregivers about their work and the treatment decisions that they make around inpatient surgical procedures. This information will be used to systematically examine how collaborative networks evolve and change in hospitals. This research will inform efforts to improve the quality and reduce the costs of surgical care while providing new insights into important social science questions about how these kinds of networks form and grow.In the last two decades social scientific research on networks has undergone a dramatic transformation as new data and methods have enabled a shift toward dynamic analysis. At the same time, work in the fields of organizational theory, economic, and cultural sociology has emphasized the contingent and situational nature of relationships, structures, and their effects. While networks of various sorts have been shown to influence individual and collective outcomes in a wide range of substantive areas, the linkages between micro network dynamics, macro network structures, and their effects have yet to be fully specified. This research will take important steps toward explaining the formation and effects of a substantively important class of networks by examining the ways in which organizational arrangements, individual choices, and existing relationships shape physicians' treatment decisions and ultimately the health of larger patient populations in individual hospitals and broader healthcare markets. This mechanism-based approach to understanding how physician relationships form, reproduce, and change in particular organizations and treatment situations integrates work on the collective dynamics of large-scale networks with theories that emphasize the organizational and institutional contexts in which relationships emerge, gain meaning, and exert their effects. The theoretically anchored, observational, and interview-based field work that we propose herein seeks to clarify the complicated processes by which networks evolve while identifying specific mechanisms, scope conditions, and contingencies that span individual preferences, structural pressures, and organizational constraints or opportunities.