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。在术前和术后护理过程中，单个患者会看到许多医生和其他护理提供者。手术本身也涉及多名外科医生和其他护理人员。 在外科护理过程中，医生们共同努力建立的关系创造了团队合作网络，对护理的质量和效率具有重要意义。这项研究将观察和采访医生，护士和其他照顾者关于他们的工作和治疗决定，他们周围的住院手术。这些信息将被用来系统地研究合作网络如何在医院发展和变化。这项研究将为提高手术护理质量和降低手术护理成本提供信息，同时为有关这类网络如何形成和发展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的出现，网络社会科学研究经历了巨大的转变，转向了动态分析。与此同时，组织理论、经济学和文化社会学领域的工作强调了关系、结构及其影响的偶然性和情境性。虽然各种网络已被证明在广泛的实质性领域影响个人和集体的结果，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塑造医生的治疗决策以及最终在单个医院和更广泛的医疗保健市场中更大患者群体的健康的方式，来解释一个非常重要的网络类别的形成和影响。这种以机制为基础的方法来理解医生的关系如何形成，复制，并在特定的组织和治疗情况下的变化整合工作的集体动态的大规模网络与理论，强调组织和制度的背景下，关系出现，获得意义，并发挥其影响。 我们在此提出的理论锚定，观察和访谈为基础的实地工作，旨在澄清网络发展的复杂过程，同时确定特定的机制，范围条件，以及跨越个人偏好，结构压力和组织约束或机会的突发事件。

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.