Arch Hellen Med, 2007, 24(Supplement 1):93-112
Sociometry and health services: An analysis of health and management networks
M. CHRYSAKIS,1 J. YFANTOPOULOS2
OBJECTIVE The purpose of the present study is the theoretical foundation and the indicative empirical application of the sociometric approach in the investigation of informal relations, collaborations and communications in the hospitals.
METHOD A middle size NHS (public) general hospital of 700 employees situated in Athens area was selected to conduct our research. The informal relations, collaborations and communications among the hospital staff were investigated by a face to face questionnaire addressed to directors of all clinical, nursing and administrative units (clinics, surgeries, laboratories, nursing stations, administrative departments), using sociometric methodologies. Three criteria were developed: (a) the criterion of "collaboration", (b) the criterion of "evaluation of operation", and (c) the criterion of "preference of collaboration". A sociometric analysis is explored using sociometric tests which are depicted in a two dimensional socio-matrix (NxN). The components of the socio-matrix correspond to answers received by the subjects under investigation. Furthermore, in order to analyse the above three criteria, synthetic indicators are specified examining the cohesion of expressed views by the employees using "the indicator of cohesion" (ICi), as well as the prestige in the public management decision making by "the indicator of prestige" (ISPi).
RESULTS The sociometric research revealed a spectrum of informal networks of communication and collaboration between the medical clinics, nursing stations, and administrative departments. The medical sector presents a high degree of internal collaboration and communication among the medical staff within the medical units and a low degree of communication with the rest of the non medical departments. The lowest level of communication networks appears to be among the administrators as well as between the administrators and the medical and nursing personnel. It was expressed by doctors and nurses that they confront significant bureaucratic barriers in their communication with the administration. Both medical and nursing units assign low and even negative values for their communication and collaboration with the administrative personnel. On the contrary, the nursing departments appear to achieve the highest values of communication and collaboration not only among the nursing personnel within the hospital, but also with their medical network channels. In this sense the nursing personnel represent the backbone of internal networks in the hospital ensuring the highest levels of internal cohesion among themselves, and relatively constructive channels of networking with the medical and administrative units. Their estimated indicator of cohesion is (IC[N]=0.74). On the contrary, the estimated indicators of cohesion for the medical and administrative staff present the lowest values (IC[I]=0.142 and IC[D]=0.07), respectively. Considering as a unified team the departments of medicine and nursing the estimated coefficient of cohesion is lather low (ICI&N=0.174). Similar conclusions are reached if we estimate the overall coefficient of cohesion for all departments (medical, nursing and administrative) (IC[S]=0.142). Finally, as far as the indicator of prestige is concerned, once more, the estimated values of administrative personnel are rather low and the corresponding estimates for the medical and nursing personnel are much higher.
CONCLUSIONS Examining the informal structures for the medical, nursing, and administrative department we found a relative high degree of internal uniformity. The nursing stuff presents the highest values of the internal cohesion and influences the overall informal networks among the hospital personnel. On the base of the sociometric findings we may conclude that sociometry is a valuable managerial tool to assess and improve the medical, nursing, and administrative communication and collaboration among the hospital personnel.
Key words: Administrative cohesion, Health services, Management and organizational networks, Sociometry.