Determinants of knowledge-sharing networks in primary care

Background. Around the world, health reforms are increasingly fostering collaboration and integration among primary care physicians with the aim of facilitating knowledge sharing and evidence-informed decision making. Although extant research on this topic is abundant, the evidence and results regarding social and organizational factors affecting the formation of knowledge-sharing networks in this setting are inconclusive. Purposes. The aim of this article is to explore multiple theoretical mechanisms explaining the formation of knowledge-sharing networks among primary care physicians across relevant clinical areas. Methodology/Approach. The data are collected from two local health authorities (LHAs) in the Italian National Health Service that are responsible for delivering primary care in two Italian regions. Exponential random graph models are used to test the hypotheses. Findings. Our findings indicate that knowledge-sharing networks are highly correlated across clinical areas. In addition, knowledge-sharing networks are highly reciprocal and clustered. We also observe that formal models adopted to foster collaboration have remarkably different effects on the formation of knowledge networks, depending upon the diverse knowledge management approaches adopted in the surveyed LHAs. Practice Implications. Primary care organizations need to develop and implement knowledge management practices in order to help physicians in identifying knowledge domain experts as well as to support connections through formal groupings and incentives

From network ties to network structures: Exponential Random Graph Models of interorganizational relations

Theoretical accounts of network ties between organizations emphasize the interdependence of individual intentions, opportunities, and actions embedded in local configurations of network ties. These accounts are at odds with empirical models based on assumptions of independence between network ties. As a result, the relation between models for network ties and the observed network structure of interorganizational fields is problematic. Using original fieldwork and data that we have collected on collaborative network ties within a regional community of hospital organizations we estimate newly developed specifications of Exponential Random Graph Models (ERGM) that help to narrow the gap between theories and empirical models of interorganizational networks. After controlling for the main factors known to affect partner selection decisions, full models in which local dependencies between network ties are appropriately specified outperform restricted models in which such dependencies are left unspecified and only controlled for statistically. We use computational methods to show that networks based on empirical estimates produced by models accounting for local network dependencies reproduce with accuracy salient features of the global network structure that was actually observed. We show that models based on assumptions of independence between network ties do not. The results of the study suggest that mechanisms behind the formation of network ties between organizations are local, but their specification and identification depends on an accurate characterization of network structure. We discuss the implications of this view for current research on interorganizational networks, communities, and field

Il trasferimento tecnologico della ricerca scientifica alle imprese

2008-07-22Sala conferenze CIS, CagliariPresentazione del Laboratorio biocombustibili e biomass

Assimilation and differentiation: A multilevel perspective on organizational and network change

This paper builds on recently derived stochastic actor-oriented models (SAOMs) for the coevolution of one-mode and two-mode networks, and extends them to the analysis of how concurrent multilevel processes of (internal) organizational and (external) network change affect one another over time. New effects are presented that afford specification and identification of two apparently conflicting micro-relational mechanisms that jointly affect decisions to modify the portfolio of internal organizational activities. The first mechanism, assimilation, makes network partners more similar by facilitating the replication and diffusion of experience. The second mechanism, functional differentiation, operates to maintain and amplify differences between network partners by preventing or limiting internal organizational change. We illustrate the empirical value of the model in the context of data that we have collected on a regional community of hospital organizations connected by collaborative patient transfer relations observed over a period of seven years. We find that processes of social influence conveyed by network ties may lead both to similarity and differences among connected organizations. We discuss the implications of the results in the context of current research on interorganizational networks

Attention to ideas! Exploring idea survival in internal crowdsourcing

Purpose \u2013 This paper analyzes how the distribution and structure of employees\u2019 attention influence idea survival in an organizational internal crowdsourcing session. Design/methodology/approach \u2013 Data from an online internal crowdsourcing session carried out within a multinational company with headquarters in Sweden were used to explore how idea attention influenced idea survival. Findings \u2013 Our findings indicate that the positive relationship between attention allocation and idea survival is mediated by idea appreciation, i.e. positive comments and suggestions that employees provide in response to ideas. In addition, we find that competition for attention negatively moderates the relationship between idea attention and positive comments. Finally, our results indicate that ideas are more likely to survive if they are submitted earlier in the crowdsourcing process and when the elapsed time since previously posted ideas in the session is longer. Practical implications \u2013 This study provides organizers of internal crowdsourcing sessions with new insights about factors influencing idea survival and about potential systematic biases in idea selection due to timing and competition between ideas. Originality/value \u2013 This paper contributes to the literature highlighting the relevance of attention-based theory in the context of crowd-based creativity and innovation management

Investigating the temporal dynamics of inter-organizational exchange: patient transfers among Italian hospitals

Previous research on interaction behavior among organizations (resource exchange, collaboration, communication) has typically aggregated records of those behaviors over time to constitute a ‘network’ of organizational relationships. We instead directly study structural-temporal patterns in organizational exchange, focusing on the dynamics of reciprocation. Applying this lens to a community of Italian hospitals during the period 2003-2007, we observe two mechanisms of interorganizational reciprocation: organizational embedding and resource dependence. We flesh out these two mechanisms by showing how they operate in distinct time frames: Dependence operates on contemporaneous exchange structures, whereas embedding develops through longer-term historical patterns. We also show how these processes operate differently in competitive and noncompetitive contexts, operationalized in terms of market differentiation and geographic space. In noncompetitive contexts, we observe both logics of reciprocation, dependence in the short term and embedding over the long term, developing into patterns of generalized exchange in this population. In competitive contexts, we observe neither form of reciprocation and instead observe the microfoundations of status hierarchies in exchange

TURVALLISESTI MAAILMAAN Yhteispäivystyksen hoitohenkilökunnan osaamisen kehittäminen matkasynnytysvalmiuteen

Tämä opinnäytetyö on suunnattu Pohjois-Karjalan sairaanhoito ja sosiaalipalvelujen kuntayhtymän (PKSSK) yhteispäivystyksen hoitohenkilökunnalle. Opinnäytetyön tarkoituksena on järjestää koulutusta yhteispäivystyksen hoitohenkilökunnalle. Koulutuksessa käydään läpi synnytyksen eri vaiheet ja avustaminen matkasynnytyksessä. Opinnäytetyön tavoitteena on, että jokaisella koulutukseen osallistuvalla olisi perusvalmiudet avustaessaan mahdollisessa matkasynnytyksessä. Opinnäytetyö sai alkunsa opinnäytetyön tekijän omasta kokemuksesta ja muun yhteispäivystyksen hoitohenkilökunnan kanssa käydyistä keskusteluista. Keskusteluissa tuli esille, että tiedot ja taidot ovat puutteelliset, jos he joutuisivat avustamaan synnytyksessä. Opinnäytetyö on toteutettu toimintatutkimuksena, ja opinnäytetyön tuotos on valokuvien kanssa tehty PowerPoint-esitys synnytyksen vaiheista. Opinnäytetyötä varten on kerätty anonyymisti tietoa koulutustarpeesta ja siitä, millaista koulutusta haluttiin järjestettäväksi. Kyselyyn vastasi kolmannes (n=32) yhteispäivystyksen hoitajista. Opinnäytetyö on ajankohtainen ja hyödyllinen, koska esimerkiksi synnytyssairaaloiden lakkauttamisen takia välimatkat synnytyssairaaloihin ovat pidentyneet ja matkasynnytykset lisääntyneet. Yhteispäivystyksessä täytyy olla valmius erilaisten yllättävien tilanteiden varalle ja yksi tällainen tilanne on matkasynnytyksessä avustaminen. Opinnäytetyön tuotos on vapaasti käytettävissä koko PKSSK:n alueella, koska se on lisätty PKSSK:n oppimateriaaleihin. Vastaavia opinnäytetöitä on tehty esimerkiksi ambulanssi henkilökunnalle, mutta niissä koulutusmateriaali on suunniteltu ambulanssissa tai kotona tapahtuvaa synnytystä varten.The thesis targets nursing staff of the emergency department at North Karelia Medical care and Social Services (PKSSK). The objective of the thesis is to help provide in out-of-hospital delivery to the staff. The training covers the different phases of the child-birth and assisting in an out-of-hospital delivery.The purpose of the thesis is to ensure that all participants will have the basic skills in assisting in an out-of-hospital delivery. The idea of this thesis rose from the personal experiences of the thesis author and from the discussions with other nursing staff members at the emergency department. It became evident that both skills and knowledge were considered as inadequate to assist in an ouf-ofhospital delivery. The thesis has been carried out as an action research, and the educational material will be performed as a PowerPoint presentation with photographs of the different steps of child birth. The information about what kind of education is needed at the emergency department was collected anonymously. The third (=32) of the nursing staff answered to the inquiry. The thesis is useful and current, because closing several maternity hospitals has increased the distances between hospitals and therefore also the out-of-hospital deliveries have increased. Emergency departments have to be prepared for different kinds of unexpected situations, out-of-hospital deliveries being one of them. The output of this bachelor’s thesis is freely available for use in every department in PKSSK and can be found in educational materials in PKSSK intranet. Similar theses have been made, for example, for paramedics, the difference being in focusing on child births in an ambulance or in one’s home

The Impact of School and After-School Friendship Networks on Adolescent Vaccination Behavior

Psychological and social characteristics of individuals are important determinants of their health choices and behaviors. Social networks represent "pipes" through which information and opinions circulate and spread out in the social circle surrounding individuals, influencing their propensity toward important health care interventions. This paper aims to explore the relationship between students' vaccination health choices and their social networks. We administered a questionnaire to students to collect data on individual students' demographics, knowledge, and attitudes about vaccinations, as well as their social networks. Forty-nine pupils belonging to 4 classrooms in an Italian secondary school were enrolled in the study. We applied a logistic regression quadratic assignment procedure (LR-QAP) by regressing students' positive responsive behavior similarity as a dependent variable. LRQAP findings indicate that students' vaccination behavior similarity is significantly associated with after-school social ties and related social mechanisms, suggesting that pupils are more likely to share information and knowledge about health behaviors through social relationships maintained after school hours rather than through those established during the school day. Moreover, we found that vaccination behaviors are more similar for those students having the same ethnicity as well as for those belonging to the same class. Our findings may help policymakers in implementing effective vaccination strategies

Assessing social and economic impact of subcutaneous mAbs in oncology

Background: Rituximab and trastuzumab were the first monoclonal antibodies (mAbs) approved for the treatment of cancer patients. Both antibodies are administered intravenously (EV), but subcutaneous (SC) formulations have recently been developed. SC formulations proved to be as safe and effective as EV and to offer substantial benefits to the patient. Objective: The aim of this study was to provide a multidimensional assessment of the impact of rituximab and trastuzumab SC compared to the EV formulation, providing a particular focus on expected social and economic benefits for the patient. Methods: The best established HTA methods were applied to gather and organize evidence concerning the clinical, economic, organizational, social and ethical impact of SC formulations of rituximab and trastuzumab. Social aspects were investigated applying regression methods to data collected with a previous research, while the potential savings associated with the use of SC formulations were estimated by a simple economic model applying the societal perspective. Results Patients undergoing subcutaneous formulation are significantly more satisfied with their treatment experience than those treated with intravenous formulation. Subcutaneous formulation reduces patient dosing times, with a positive effect on the care provider's autonomy and productivity. Potential savings associated with the use of rituximab SC were estimated in € 4,050 per patient per year on average. For trastuzumab SC the estimated potential savings amounted to € 3,400 per patient per year, on average. Conclusion Rituximab and trastuzumab are promising treatment options significantly improving patients qol and reducing the treatment burden in terms of societal costs

Validation of a guideline to reduce variability in diagnosing cervical dystonia

Background: Cervical dystonia is characterized by a variable pattern of neck muscle involvement. Due to the lack of a diagnostic test, cervical dystonia diagnosis is based on clinical examination and is therefore subjective. The present work was designed to provide practical guidance for clinicians in confirming or refuting suspected cervical dystonia. Methods: Participants were video recorded according to a standardized protocol to assess 6 main clinical features possibly contributing to cervical dystonia diagnosis: presence of repetitive, patterned head/neck movements/postures inducing head/neck deviation from neutral position (item 1); sensory trick (item 2); and red flags related to conditions mimicking dystonia that should be absent in dystonia (items 3-6). Inter-/intra-rater agreement among three independent raters was assessed by k statistics. To estimate sensitivity and specificity, the gold standard was cervical dystonia diagnosis reviewed at each site by independent senior neurologists. Results: The validation sample included 43 idiopathic cervical dystonia patients and 41 control subjects (12 normal subjects, 6 patients with isolated head tremor, 4 with chorea, 6 with tics, 4 with head ptosis due to myasthenia or amyotrophic lateral sclerosis, 7 with orthopedic/rheumatologic neck diseases, and 2 with ocular torticollis). The best combination of sensitivity and specificity was observed considering all the items except for an item related to capability to voluntarily suppress spasms (sensitivity: 96.1%; specificity: 81%). Conclusions: An accurate diagnosis of cervical dystonia can be achieved if, in addition to the core motor features, we also consider some clinical features related to dystonia mimics that should be absent in dystonia