IDEAS home Printed from
   My bibliography  Save this article

Hierarchies and cliques in the social networks of health care professionals: implications for the design of dissemination strategies


  • West, Elizabeth
  • Barron, David N.
  • Dowsett, Juliet
  • Newton, John N.


Interest in how best to influence the behaviour of clinicians in the interests of both clinical and cost effectiveness has rekindled concern with the social networks of health care professionals. Ever since the seminal work of Coleman et al. [Coleman, J.S., Katz, E., Menzel, H., 1966. Medical Innovation: A Diffusion Study. Bobbs-Merrill, Indianapolis.], networks have been seen as important in the process by which clinicians adopt (or fail to adopt) new innovations in clinical practice. Yet very little is actually known about the social networks of clinicians in modern health care settings. This paper describes the professional social networks of two groups of health care professionals, clinical directors of medicine and directors of nursing, in hospitals in England. We focus on network density, centrality and centralisation because these characteristics have been linked to access to information, social influence and social control processes. The results show that directors of nursing are more central to their networks than clinical directors of medicine and that their networks are more hierarchical. Clinical directors of medicine tend to be embedded in much more densely connected networks which we describe as cliques. The hypotheses that the networks of directors of nursing are better adapted to gathering and disseminating information than clinical directors of medicine, but that the latter could be more potent instruments for changing, or resisting changes, in clinical behaviour, follow from a number of sociological theories. We conclude that professional socialisation and structural location are important determinants of social networks and that these factors could usefully be considered in the design of strategies to inform and influence clinicians.

Suggested Citation

  • West, Elizabeth & Barron, David N. & Dowsett, Juliet & Newton, John N., 1999. "Hierarchies and cliques in the social networks of health care professionals: implications for the design of dissemination strategies," Social Science & Medicine, Elsevier, vol. 48(5), pages 633-646, March.
  • Handle: RePEc:eee:socmed:v:48:y:1999:i:5:p:633-646

    Download full text from publisher

    File URL:
    Download Restriction: Full text for ScienceDirect subscribers only

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    1. Johansson,Per-Olov, 1995. "Evaluating Health Risks," Cambridge Books, Cambridge University Press, number 9780521478786, March.
    2. Cropper, M L, 1981. "Measuring the Benefits from Reduced Morbidity," American Economic Review, American Economic Association, vol. 71(2), pages 235-240, May.
    3. Wagstaff, Adam, 1986. "The demand for health : Some new empirical evidence," Journal of Health Economics, Elsevier, vol. 5(3), pages 195-233, September.
    4. Grossman, Michael, 1972. "On the Concept of Health Capital and the Demand for Health," Journal of Political Economy, University of Chicago Press, vol. 80(2), pages 223-255, March-Apr.
    5. Christian Dustmann, 1996. "The social assimilation of immigrants," Journal of Population Economics, Springer;European Society for Population Economics, vol. 9(1), pages 37-54, February.
    6. Amemiya, Takeshi, 1981. "Qualitative Response Models: A Survey," Journal of Economic Literature, American Economic Association, vol. 19(4), pages 1483-1536, December.
    7. Michael Grossman, 1972. "The Demand for Health: A Theoretical and Empirical Investigation," NBER Books, National Bureau of Economic Research, Inc, number gros72-1, January.
    8. Veall, Michael R & Zimmermann, Klaus F, 1996. " Pseudo-R-[superscript 2] Measures for Some Common Limited Dependent Variable Models," Journal of Economic Surveys, Wiley Blackwell, vol. 10(3), pages 241-259, September.
    9. Cameron, A Colin & Trivedi, Pravin K, 1986. "Econometric Models Based on Count Data: Comparisons and Applications of Some Estimators and Tests," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 1(1), pages 29-53, January.
    10. Winfried Pohlmeier & Volker Ulrich, 1995. "An Econometric Model of the Two-Part Decisionmaking Process in the Demand for Health Care," Journal of Human Resources, University of Wisconsin Press, vol. 30(2), pages 339-361.
    11. Torrance, George W., 1986. "Measurement of health state utilities for economic appraisal : A review," Journal of Health Economics, Elsevier, vol. 5(1), pages 1-30, March.
    12. Johansson,Per-Olov, 1995. "Evaluating Health Risks," Cambridge Books, Cambridge University Press, number 9780521472852, March.
    Full references (including those not matched with items on IDEAS)


    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.

    Cited by:

    1. McAneney, H. & McCann, J.F. & Prior, L. & Wilde, J. & Kee, F., 2010. "Translating evidence into practice: A shared priority in public health?," Social Science & Medicine, Elsevier, vol. 70(10), pages 1492-1500, May.
    2. Barrington, Clare & Latkin, Carl & Sweat, Michael D. & Moreno, Luis & Ellen, Jonathan & Kerrigan, Deanna, 2009. "Talking the talk, walking the walk: Social network norms, communication patterns, and condom use among the male partners of female sex workers in La Romana, Dominican Republic," Social Science & Medicine, Elsevier, vol. 68(11), pages 2037-2044, June.
    3. Lessard, Chantale & Contandriopoulos, André-Pierre & Beaulieu, Marie-Dominique, 2010. "The role (or not) of economic evaluation at the micro level: Can Bourdieu's theory provide a way forward for clinical decision-making?," Social Science & Medicine, Elsevier, vol. 70(12), pages 1948-1956, June.
    4. Fattore, Giovanni & Frosini, Francesca & Salvatore, Domenico & Tozzi, Valeria, 2009. "Social network analysis in primary care: The impact of interactions on prescribing behaviour," Health Policy, Elsevier, vol. 92(2-3), pages 141-148, October.
    5. Facundo Albornoz & Antonio Cabrales & Esther Hauk, 2017. "Occupational Choice with Endogenous Spillovers," Working Papers 972, Barcelona Graduate School of Economics.
    6. repec:spr:infosf:v:12:y:2010:i:1:d:10.1007_s10796-009-9167-y is not listed on IDEAS
    7. Allen, Pauline & Croxson, Bronwyn & Roberts, Jennifer A. & Archibald, Kate & Crawshaw, Shirley & Taylor, Lynda, 2002. "The use of contracts in the management of infectious disease related risk in the NHS internal market," Health Policy, Elsevier, vol. 59(3), pages 257-281, March.
    8. Mascia, Daniele & Dandi, Roberto & Di Vincenzo, Fausto, 2014. "Professional networks and EBM use: A study of inter-physician interaction across levels of care," Health Policy, Elsevier, vol. 118(1), pages 24-36.
    9. Paul, Sudeshna & Keating, Nancy L. & Landon, Bruce E. & O'Malley, A. James, 2014. "Results from using a new dyadic-dependence model to analyze sociocentric physician networks," Social Science & Medicine, Elsevier, vol. 117(C), pages 67-75.
    10. Dunn, Adam G. & Westbrook, Johanna I., 2011. "Interpreting social network metrics in healthcare organisations: A review and guide to validating small networks," Social Science & Medicine, Elsevier, vol. 72(7), pages 1064-1068, April.
    11. Paola Zappa, 2011. "The network structure of knowledge sharing among physicians," Quality & Quantity: International Journal of Methodology, Springer, vol. 45(5), pages 1109-1126, August.
    12. Lewis, Jenny M., 2006. "Being around and knowing the players: Networks of influence in health policy," Social Science & Medicine, Elsevier, vol. 62(9), pages 2125-2136, May.
    13. Paul, Sudeshna & Keating, Nancy L. & Landon, Bruce E. & O’Malley, A. James, 2015. "Reprint of: Results from using a new dyadic-dependence model to analyze sociocentric physician networks," Social Science & Medicine, Elsevier, vol. 125(C), pages 51-59.

    More about this item


    Access and download statistics


    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:48:y:1999:i:5:p:633-646. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Dana Niculescu). General contact details of provider: .

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    We have no references for this item. You can help adding them by using this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.