Networking for healthcare reform
Authors: E Stanton, C Lemer
Journal: Journal of the Royal Society of Medicine (2010)

In 2007, the New England Journal of Medicine published a seminal paper examining the causation and management of obesity.1 The paper used complex modelling techniques and produced clear robust findings. However, the intervention was neither a drug nor a surgical procedure. Nor was it a re-design of the health service. Rather it was an examination of the effect of networks. This was one of the first occurrences where the effect of connections was proven to have an impact on health outcomes. Subsequently, the authors of this paper have gone on to examine the effect of social networks beyond health in a very successful book – Connected.

Healthcare, having been at the vanguard of this development, is now embracing the potentially beneficial effect of networks in different ways. Perhaps the most interesting aspect is the development of online social networks.


Online social networks can be used to solve collective problems more easily. The most famous example of online peer production using social capital is Wikipedia.org . With over 9 million users, Wikipedia taps into the wisdom of many, rather than relying on solitary experts. Given how fast the web is developing, the potential is enormous. 

‘It took just 40 years for the first 50 million people to own a radio; just 16 years for the first 50 million people to own a PC; but just 5 years for the first 50 million to be on the Internet.’2

The World Wide Web first emerged in 1990. Since then, the impact of technology on social networks has been profound. The three most frequently used online social network sites are Facebook, Twitter and LinkedIn. Of relevance for healthcare policymakers, online social networks have a substantial influence on the decision-making of individuals. Saatchi and Saatchi's intern recruitment strategy via Facebook is one example of the private sector's innovative use of online social networks. Entry costs to online communities are low. Therefore, individuals make connections and linkages where they might not otherwise, growing bridging capital. Comparing online and offline capital, Putnam3 found that use of the Internet thickened pre-existing relationships, rather than leading to social isolation.


A ‘network’ is defined as a set of nodes (where connections are made either through individuals or organizational units) and linkages between them.4 Such networks create the conditions that allow members to form clusters that are geared towards a particular goal (or policy initiative). This essentially means that a network has the combined synergistic power of its members and, thus, more potential than individuals acting alone. This synergistic power has been deemed social capital. Social capital is the connection between people and the resulting norms of reciprocity and trustworthiness that are created. Within this network there are different aspects to the social capital. First, there is bonding capital where strong ties are built among like-minded people, with the ability to actively exclude those who do not qualify. This is a closed but effective network, as seen in private members clubs. Bonding capital is best exemplified by professional networks or communities of practice. An example of this is the recent creation of the WHO Patient Safety Research community of practice, this group is designed to act as a forum to allow researchers to develop ideas together and ensure faster dissemination. Of particular importance to this network is the ability to integrate novice researchers, a key aim given that many countries have to date invested limited funds in this area of health services research. Often, without knowledge, there is a vicious cycle of inability to grow talent (unless individuals seek skills and training abroad – which is expensive and often, therefore, impossible).

Bridging capital is more inclusive as it links between networks. Bridging capital enables individuals to profit from new information or resources not present within their cluster. Bridging ties are often weak, i.e. those connecting do not know each other well. However, individuals with many weak ties to other clusters are best placed to diffuse innovation. Gladwell5 describes these individuals as ‘connectors’. Most effective is to pair ‘connectors’ with ‘mavens’, those constantly seeking to disseminate new information. A powerful example of this is the case of rare diseases, which affect more than 30 million people across Europe. However, many people with rare diseases feel isolated and do not have access to specialist services. Too often, they experience a lengthy delay in diagnosis and treatment.6 Since 2008, Rare Disease Day has used online social networks to bring individuals affected by rare diseases and their families together to raise political and public awareness. As of May 2010, the Facebook group for ‘Rare Disease Day 2010’ has over 10,000 members with more than 200 links to other rare disease websites uploaded. On Twitter, searching under the hash code ‘#raredisease’ reveals a realtime interactive and international online conversation peppered with news of reports, campaigns and personal experiences. Rare diseases are not the only illnesses to have harnessed the power of online social networks. This example demonstrates the opportunities for online networks to improve lines of communication and crucially, to improve the overall experience, effectiveness and safety of healthcare provided.

These are but a few of the examples of online social networks that are starting to impact on healthcare. They are important to appreciate because as access to Internet technology increases, e.g. with more mobile devices, the effect of these networks on information transfer and clinical knowledge dissemination will be profound.