Exploring the use of social network analysis in identifying physician engagement in quality improvement in the hospital setting

Physicians are an integral component in the performance of clinical process of care and patient experience measures in the hospital setting. A deeper understanding of physician influence in quality improvement by hospital leaders will be key to a hospital's success in the various programs set into motion by the Affordable Care Act (ACA) of 2010. The law, intended to put into place health insurance reforms, has an implementation timeline of four years and beyond. Many healthcare leaders across the country have been preparing for the changes in the way of services, programs, and incentives which are intended to improve quality and lower costs. One such program is the Centers for Medicare & Medicaid Services (CMS) Hospital Value Based Purchasing (VBP) program. This pay for performance program differentiates hospital inpatient payment rates based on performance in process, outcome, and patient satisfaction measures. Beginning in 2013, 1% of a hospitals inpatient Medicare payment is at risk with a 0.25% increase each year thereafter, capping at 2% in 2017. The program holds providers accountable for their success or improvement in clinical process of care and patient experience measures via a withhold/payback structure.;This research sought to explore the use of social network analysis (SNA) in identifying physician engagement in quality improvement in a hospital setting. The study involved SNA in determining level of physician prominence within a defined network to answer the following research questions: 1) How can healthcare leaders identify physicians within their organization as quality improvement "champions" in order to increase the effectiveness of their group in modeling and/or disseminating behavior change within a hospital to improve the overall quality of care outcomes? 2) How do self-perspectives on physician knowledge regarding CMS quality core measures align with other physician's perspectives on seeking out that physician's input on quality? The objective of the study was to map the relationships and communications of a network of physicians in a 265 acute care bed hospital as a means of evaluating influential discussions surrounding quality improvement initiatives. Analysis was performed and physician prominence within the network was identified and quantified mathematically by defining centrality by degree, closeness, and betweenness. Statistical inferences could not be made from the additional level of analysis in determining if relationships existed between the variables of specialty, years of service, and familiarity with CMS core measures and the VBP program. The utilization of SNA in this study provided valuable empirical information that can be utilized by healthcare leaders in identifying physician quality improvement "champions" within their organizations. The information serves as a valuable tool in assisting healthcare leaders in strategizing their approach to improve the overall quality outcomes in their organization by ensuring a more effective and engaged physician network. Future action research is recommended to identify whether or not clinical quality outcomes improve as a result of identifying physician "champions" based on network information. Physician involvement in quality improvement initiatives will be crucial to the success of hospitals in CMS at risk programs such as the VBP program and can position an organization for a more financially stable future and a sustainable culture of quality.