Building Inclusion through Organizational Network Analysis In Clinical Settings

Background: Patterns of connection, inclusion and trust within organizations often depends on access to relationships and information. In healthcare settings, where hierarchical structures and siloed teams are common, informal workplace networks can either reinforce exclusion or serve as bridges that promote collaboration and shared voice. Organizational network analysis (ONA) provides a rigorous method for examining how these relational structures shape opportunity and inclusion at work. Still, limited empirical research has examined how specific social factors influence network connectivity in healthcare organizations.

Methods: This study uses a repeated cross-sectional design to examine ONA survey data collected at three timepoints between 2022 and 2024. The ONA explored patterns of relationships and information sharing among clinical teams in large, complex hospitals in Arizona, Florida and Minnesota. Of 501 healthcare staff invited to complete the ONA, 321 (64%) responded. Participants included social workers, nurses and physicians. The ONA assessed respondents’ workplace connectivity by asking participants to identify colleagues they rely on in their daily work. Additional items captured respondent characteristics, including role, tenure, division, location and supervisory status. The surveys also measured the presence of key social factors within respondents’ professional networks including mentorship, psychological safety and friendship, as well as disenfranchisement, marginalization, cliques, collaborative overload and burnout. Respondents were also asked to identify which colleagues were perceived as supporting these factors or that they needed more access to. Analysis interpreted overall and individual network structure and examined associations between social factors and connectivity using comparative inferential methods, with stratified analyses by respondent characteristics.

Results: Findings indicate that positive social factors are associated with higher levels of network connectivity among the clinical teams. Positive social factors were also experienced most profoundly among participants who were seen as influencers or brokers across different groups. The prevenance of trust, mentorship and friendship were positively associated with larger networks. Negative social factors, including disenfranchisement, marginalization and burnout were associated with limited network connectivity. Negative social factors were also associated with individuals who were siloed from the rest of the group. Positive and negative factors differed slightly by role and tenure, with those serving in a leadership capacity and with tenure greater than 10+ years holding highest levels positive social factors and network connectivity. Hospital location (AZ, FL, MN) did not impact social factors or network connectivity.

Conclusion and Implications: This study identified a direct link between social factors and workplace network connectivity across three clinical setting. The study highlighted how workplace environments influence participation and inclusion of social workers, nurses and physicians within hospital settings. The findings demonstrated that promoting mentorship, trust and friendship may help promote more equitable and resilient workplace networks. For social work researchers and practitioners, ONAs provide an innovative tool to more accurately assess how professional networks are influenced by social factors. The findings of this study also advanced evidence-based practices that may further equip individuals and organizations with network insights needed to thrive collectively.