Integration, the coordination and alignment of tasks, is widely promoted in order to improve the performance of hospitals. Both organization theory and social network analysis offer perspectives on integration, but studies using a system-wide perspective are rare. This exploratory study describes the tasks that are performed in arranging the logistics for surgery patients in a hospital and in what way the agents involved in these tasks interact. In addition, the extent to which tasks are segmented into subsystems, which is referred to as differentiation, and whether these tasks are coordinated and aligned, thus achieving integration, is analyzed.
The study is based on case study research carried out in a hospital in the Netherlands. All logistical tasks that are executed for surgery patients were studied. Using a mixed method, data were collected from the Hospital Information System, documentation, observations and interviews. These data were used to perform a social network analysis and calculate network metrics of the hospital network.
This paper shows that 23 tasks are executed by 635 different agents who interact through 31,499 interaction links. The social network of the hospital demonstrates both integration and differentiation. The network appears to function differently from what is assumed in literature with regard to hospitals, as the network does not reflect the formal organizational structure of the hospital and tasks are mainly executed across functional silos. Nurses and physicians perform integrative tasks and there are two agents who mainly coordinate the tasks in the network, without having a hierarchical position towards other agents. The Hospital Information System (HIS) does not seem to fulfill the interactional needs of agents.
This exploratory study reveals the network structure of a hospital. The cross-functional collaboration, the integration found and position of managers, coordinators, nurses and doctors suggests a possible gap between organizational perspectives on hospitals and reality. This research sets a basis for further research that should focus on the relation between network structure and performance, on how integration is achieved and in what way organization theory concepts and social network analysis could be used in conjunction with one another.