< Additional materials are published online only. To view these ﬁles please visit the journal online (http:// qualitysafety.bmj.com/ content/21/3.toc). 1Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, Sydney, Australia 2Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, University of New South Wales, Sydney, Australia Correspondence to Dr Frances C Cunningham, Centre for Clinical Governance Research, Australian Institute of Health Innovation, Level 1, AGSM Building, University of New South Wales, Sydney, NSW 2052, Australia; f.cunningham@unsw.edu.au Accepted 1 November 2011 Published Online First 30 November 2011 This paper is freely available online under the BMJ Journals unlocked scheme, see http://qualitysafety.bmj. com/site/about/unlocked. xhtml Systematic review Health professional networks as a vector for improving healthcare quality and safety: a systematic review Frances C Cunningham,1 Geetha Ranmuthugala,1 Jennifer Plumb,1 Andrew Georgiou,2 Johanna I Westbrook,2 Jeffrey Braithwaite1 ABSTRACT Background: While there is a considerable corpus of theoretical and empirical literature on networks within and outside of the health sector, multiple research questions are yet to be answered. Objective: To conduct a systematic review of studies of professionals’ network structures, identifying factors associated with network effectiveness and sustainability, particularly in relation to quality of care and patient safety. Methods: The authors searched MEDLINE, CINAHL, EMBASE, Web of Science and Business Source Premier from January 1995 to December 2009. Results: A majority of the 26 unique studies identiﬁed used social network analysis to examine structural relationships in networks: structural relationships within and between networks, health professionals and their social context, health collaboratives and partnerships, and knowledge sharing networks. Key aspects of networks explored were administrative and clinical exchanges, network performance, integration, stability and inﬂuences on the quality of healthcare. More recent studies show that cohesive and collaborative health professional networks can facilitate the coordination of care and contribute to improving quality and safety of care. Structural network vulnerabilities include cliques, professional and gender homophily, and over-reliance on central agencies or individuals. Conclusions: Effective professional networks employ natural structural network features (eg, bridges, brokers, density, centrality, degrees of separation, social capital, trust) in producing collaboratively oriented healthcare. This requires efﬁcient transmission of information and social and professional interaction within and across networks. For those using networks to improve care, recurring success factors are understanding your network’s characteristics, attending to its functioning and investing time in facilitating its improvement. Despite this, there is no guarantee that time spent on networks will necessarily improve patient care. BACKGROUND Interest in networks as collaborating, profes- sionalised structures continues to grow. As a post-bureaucratic form of organisation,1 networks have gained increasing popularity for governments and policymakers. With a considerable corpus of literature on networks within and outside the health sector, it is timely to assess the current state of knowledge, particularly in relation to how the features of networks may be applied to improve quality and outcomes of care. ‘Network’ is a word used extensively in healthcare research and in health services delivery. It is used as a synonym for ‘part- nership’, ‘collaboration’, ‘alliance’ and ‘group’, or more speciﬁcally to describe the relationships between people, groups or organisations. A ‘social network’ is a ‘set of people or groups of people, “actors ” . with some pattern of interactions or “ties” between them . [eg,] friendships among a group of individuals, business relationships between companies’.2 There is a long history of examining social networks through network analysis techniques, with researchers focusing on structural and relationship properties.3e5 Social network analysis (SNA) can be used to examine structural relationships and inﬂu- ence in networks, the way information travels in networks, diffusion of innovative ideas, tools or practices, and sustainability of networks. It is the structure of networks and how the structural properties affect behav- iour that is informative, not simply the char- acteristics of the network members.6 7 Comprehensive reviews of the tools of SNA are provided by Knoke and Yang,8 Scott4 and Wasserman and Faust.5 The online BMJ Qual Saf 2012;21:239e249. doi:10.1136/bmjqs-2011-000187 239