Ecological Niches and Network Variations: Spatial practices and action networks of doctors, nurses and clerks in outpatient clinics

Kerstin Sailer


Network ecology is an emerging field in social network analysis putting a focus on the purposeful consideration of the multiple contexts in which networks flourish. Considering context is nothing new in social network theory and analysis. In fact, the last decades have seen emerging contributions conceptualising the social context of social networks; their organizational context; and their spatial context. In this talk, spatial practices of doctors, nurses and clerks in outpatient clinics will be investigated. The research question to be answered is: how do action networks of different practitioners vary depending on organizational and spatial context? Networks are constructed from actions of healthcare workers, i.e. the repeated performance of actions (care for a patient, walk, talk to another healthcare workers, etc.) creates repetitive but varying sequences. A tie between two activities is created if one follows the other in an observed sequence. Data from 170 hours of observation of care practices in ten different outpatient clinics, situated in two different hospitals with different care contexts will be analysed (n=8238 activities). Differentiating action networks not just by clinic, but also by role (doctor, nurse, clerk), creates a large sample with observable variations in network structure. Methods include an R analysis of action networks (based on direct observations), as well as a space syntax analysis of spatial visibility networks. The two different hospitals have very different organizational routines, which is evident from the duration of activities, which tend to be much shorter in hospital A (mean duration=60.0 sec) than in hospital B (mean duration=106.2 sec). The hospitals also have different architectural layouts with hospital A being more open plan and boasting larger viewsheds, whereas hospital B has a traditional corridor layout with more partitions and less visibility among healthcare workers. Results show that action networks are structured in relation to their spatial and organizational context. Clinics with largest local viewsheds tend to have more dynamic action networks as evident by lower average betweenness values for activities as well as higher densities in the action networks, hence a larger variation of potential activities to follow a particular activity. Analysing action networks differentiated by role shows large variations in density, betweenness and degree centralization values, where routines are structured quite differently by role within the same clinic. Within these variations, patterns emerge. For instance, clinics with longer path length in the spatial visibility network show lower density values for doctors, i.e. actions are less dynamic (as expected). However, the opposite is the case for nurses, where long paths create more dynamic action networks. Therefore, the same context creates differential opportunities for doctors and nurses. This allows a reflection on how practices are knit together to form a single care context. It also allows a discussion of ecological niches and variations in action networks. It seems that action networks are not just structured to operate within an environment but are also a product of that environment and actively responding to its cues to adapt and create variations in structure.

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