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

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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.