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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
Harness the power of social capital to improve the efficacy and efficiency of healthcare organizations
Written by Thomas Lee, Chief Medical Officer at Press Ganey, Social Capital in Healthcare describes a new and powerful framework for improving healthcare, arguing that managers should approach the work of building trust, teamwork, and high reliability with the same intensity and discipline as CFOs use when managing the finances of their organizations.
Lee's powerful framework integrates management priorities such as safety, quality, patient experience, and workforce resilience/burnout/loyalty, demonstrating through data that these “silos” are in fact intertwined, and the work of improving them is best taken on with a single focus: improving social capital.
In this book, readers will learn about:
- Key social capital themes in healthcare, including trust, respect, connectedness, and teamwork
- The necessity of social capital in healthcare due to changes in medicine, patients, and society
- Building social capital through transitivity, reciprocity, bridging connections, and driving the right values
- Social capital initiatives at institutions such as the Mayo Clinic, Houston Methodist, and Vanderbilt University Medical Center
Drawing upon deeply respected work from sociology, psychology, and business strategy, Social Capital in Healthcare earns a well-deserved spot on the bookshelves of all forward-thinking healthcare executives, managers, and consultants.
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Seitenzahl: 256
Veröffentlichungsjahr: 2025
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Table of Contents
Cover
Table of Contents
Title Page
Copyright
Dedication
Preface
Introduction
Chapter 1: A Primer on Social Capital
Social Capital's Arrival
The Currencies of Social Capital: Reciprocity and Trust
The Instruments of Social Capital
Chapter 2: Why Healthcare Needs Social Capital Now
Medicine Is Changing
Patients Are Changing
Healthcare Providers Are Changing
Society Is Changing
Chapter 3: Building, Strengthening, and Using Social Capital Connections
Connections with Patients
Connections with Individual Employees
Connections Within and Among Teams
Connections Within Organizations
Chapter 4: Building Teams and Networks in Healthcare
Building Great Teams on the Front Lines of Care
Building a Team of Teams
Using Meetings to Build Teams
Building Social Networks Within the Organization
Using Social Networks to Disseminate Values
Chapter 5: Measuring Social Capital
Principles of Measuring Social Capital
Key Measures of Social Capital
Analyzing Data at Different Organizational Levels
Chapter 6: Social Capital as the Core of Healthcare Strategy
The Five Forces That Should Shape Strategy
Strategy as the Antidote to Competition
Chapter 7: How to Be a Chief Officer for Social Capital
Establishing Objectives for Building Social Capital
Thinking Like a CO for Social Capital
Acting Like a CO for Social Capital
Building Social Capital by Instilling Hope
References
Acknowledgments
About the Author
Index
End User License Agreement
List of Tables
Chapter 2
Table 2.1 Atrius in‐basket volume reduction, 2017–2022.
Chapter 5
Table 5.1 Subsets of workplace survey items that are relevant to social cap...
Table 5.2 Subset of items from patient experience surveys.
Table 5.3 Open‐ended comments about respect from patient experience surveys...
Table 5.4 Employee engagement items relevant to different organizational le...
Chapter 7
Table 7.1 Common themes identified in responses to the questions about resp...
Table 7.2 Top 10 ideas revealed in popular voting.
Table 7.3 Design intent and proposed solution to foster a culture of respec...
List of Illustrations
Chapter 2
Figure 2.1 Audit of compliance with standards of note quality.
Figure 2.2 Percentage of notes meeting criteria for clinical assessment and ...
Figure 2.3 Trends in volume of CC chart messages and CC chart volume, 2016–2...
Chapter 3
Figure 3.1 Correlation between patients' “recommend the hospital” scores and...
Chapter 4
Figure 4.1 Correlation of workforce ratings on organizational respect with p...
Figure 4.2 CHS serious safety event rate over time.
Chapter 5
Figure 5.1 Correlation between hospital workforce engagement and patients' l...
Figure 5.2 Correlation between organizational diversity and equity scores an...
Figure 5.3 Median and 10th–90th percentiles for employee engagement by year....
Figure 5.4 Impact of safety concerns on patients' likelihood to recommend th...
Figure 5.5 Safety culture items and changes from 2023 to 2024.
Guide
Cover Page
Table of Contents
Title Page
Copyright
Preface
Introduction
Begin Reading
References
Acknowledgments
About the Author
Index
End User License Agreement
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“This compelling book illustrates how social capital is the key to turning healthcare around.”
–AMY C. EDMONDSON, PhD
Novartis Professor of Leadership and Management at Harvard Business School and author of Right Kind of Wrong
SOCIAL CAPITAL IN HEALTHCARE
HOW TRUST AND TEAMWORK DRIVE ORGANIZATIONAL EXCELLENCE
THOMAS H. LEE, MD
CHIEF MEDICAL OFFICER, PRESS GANEY
AND EDITOR‐IN‐CHIEF, NEJM CATALYST
Copyright © 2025 by Press Ganey Associates, LLC. All rights reserved.
Published by John Wiley & Sons, Inc., Hoboken, New Jersey.Published simultaneously in Canada.
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Cover Design: WileyCover Image: © Moyo Studio/Getty ImagesAuthor Photo: © Press Ganey
To Michael E. Porter, PhD, MBA
Bishop William Lawrence University Professor
Harvard Business School
Who taught me and so many others to focus on measuring what matters and organize around its improvement—the ideas at the core of this book.
Preface
Creating social capital is something that comes naturally to most people – especially people who are drawn to the good work of healthcare. Social capital is generated by creating social networks and using them to improve what we do. We tend to enjoy building connections with others in our personal and professional lives. We like to strengthen those connections, too. We value being able to work with people we like and trust.
But building social capital so that our organizations do more for our patients with high reliability and earn the loyalty of our colleagues – now, that takes work. It takes discipline. It means building real connections with everyone on the team. It means making sure everyone knows that they are on a team. It means creating a culture in which everyone – patients and colleagues – feels respected.
It means building connections across teams and across organizations. It means using those connections to spread information quickly and reliably, so we can respond to the challenges of the moment and the challenges of our times. It means creating a context in which people trust each other because they understand what it takes to be trustworthy.
Building social capital is difficult work – but it is the best work. It is the kind of work that causes you to smile gently every now and then as you drive home after a good day. Most of us feel that this is the kind of work we would do without the need for compensation. In fact, research shows that managers who are better at building social capital are valued more highly by their organizations and get promoted more quickly.
This book is written to help managers and leaders thrive by enhancing their ability to create social capital for their organizations. I don't think readers will find any of the recommendations controversial; after all, who can be against building connections among people and putting them to good use? But I hope the framing of these recommendations will help managers and leaders focus on the steps that build social capital.
I write this fully aware that “focusing” is not easy in healthcare even when the goal has obvious importance, like the building of social capital. There are so many signals coming in from so many directions in healthcare all the time, and every one of them feels like a crisis. There are health crises, like the COVID‐19 pandemic. There are social crises that result from bias and inequity. There are financial crises due to the high costs of healthcare. And, of course, for each individual patient, there are their own medical crises that must be addressed with urgency.
In healthcare, we are better wired for responding to urgency than focusing on steps to build capital of any kind – financial or social. However, healthcare's current challenges demonstrate that working hard in response to crises is not enough. We need to be able to step back and understand what types of organizational changes will enable us to deliver better care and then implement them with high reliability.
My personal education on the types of organizational changes that are essential to building social capital began one June day in 2006, when I had my first real interaction with Michael E. Porter, a professor from Harvard Business School who would subsequently become my colleague, coauthor, and good friend. Porter was already widely known as one of the most powerful thinkers about business strategy, and he had just published Redefining Health Care – a book (written with Elizabeth Teisberg) that overnight had found a place on virtually every healthcare leader's bookshelf (Porter and Teisberg 2006).
I had invited Porter to lunch with me and my boss, Jim Mongan, CEO of what was then Partners Healthcare System (now MassGeneral Brigham) because he posed a problem. My job at that time was network president for Partners. I was responsible for building the network of physicians and hospitals around Massachusetts General Hospital and Brigham and Women's Hospital and improving their quality and efficiency. The goals of this work were idealistic, but they were also strategic. We were negotiating contracts with payers as an integrated delivery system, and we were getting compensated at higher levels than other providers because, in theory, the whole of our system was greater than the sum of its parts.
We were successful enough in those contract negotiations that we were attracting criticism from health insurance companies, other providers, and some government officials. Then, in the spring of 2006, we heard that Porter was saying in public remarks that Partners was not really an integrated delivery system. A powerful voice had joined the chorus of our critics.
“That's not good,” Mongan said to me. “Ask him if he would come over so we can tell him all the things we are doing to integrate our care.” I reached out to Porter and invited him to lunch; he agreed, and a few weeks later, I found myself sitting with Mongan across the table from arguably the most respected expert on business strategy in the world.
I had printed out PowerPoints showing how we were implementing electronic health records (EHRs) across our system. We were not only making an EHR available, but we required physicians to adopt it. We were the first network in the country to tell doctors that if they didn't adopt an EHR, we would exclude them from our network and our contracts. (We ultimately excluded about 35 doctors who refused to come along; it was not pleasant.)
Porter paid close attention, writing notes on his yellow pad. He nodded when I described the decision support that we were integrating into our EHR to help doctors make safer and more efficient choices. I paused to give him a chance to compliment us on our work.
“That's all very lovely,” he said. This was the moment when I learned that if you hear the word “lovely” in a business context, you are not going to like what is coming next. He continued, “But it's not the same thing as organizing around the needs of patients.”
My heart sank, because I knew immediately that he was right. We were working hard to make doctors faster, safer, and even more efficient at doing what doctors do, but we had not really done much to reorganize what they did.
Mongan made some hand motions to tell me to keep going. I went to the pages in the PowerPoint presentation that described the financial incentives we had created to reward physicians who improved on their quality metrics and/or decreased their spending for the overall population.
Again, Porter nodded. And, again, he said, “Yes, that's all very good. But it's not the same as organizing around the needs of patients.”
After a few more minutes of playing defense, I surrendered. I said, “Michael, if you were us, what would you do?”
“I would make Partners the world's leaders in measuring what matters to patients,” he said. “Capture those data and put them in front of your doctors. You are good people and you are smart people. You will respond and you will figure out how to make care better. But if you don't measure what matters to patients, you can't.”
I was taking notes and wrote, “Measure what … ” in my notebook, but then stopped. Porter was sitting only a few feet away across the narrow table and could see what I wrote. I thought that he must be wondering, “What are they paying this guy for if he has to write down that they should measure what matters to patients?”
But his suggestion was a big one. He was recommending that Partners and the rest of healthcare organize around a new focus – improving what matters to patients. We had never been against that goal, of course. But Porter was suggesting that we make it our explicit top priority and organize ourselves accordingly.
“If you want to discuss what it means to go down this road, come on over and we can continue the conversation,” he said.
And the very next day, I did.
Years later, when Porter and I were making our way through a crowd entering Fenway Park for a Red Sox game, I recalled that afternoon when we had met – and told him that after he left, several of my colleagues were waiting in a conference room to hear what had happened during the meeting with him. I told them, “He said we should measure what matters to patients.” They had all bent over and furiously written in their notebooks, “Measure what matters to patients.”
Porter laughed. “Don't feel bad about writing that down,” he said. “This is what happens in every organization among people doing real work. They get so close to it that they can lose sight of the big picture.
“I have a great job,” he continued. “I come in and say the obvious thing. And then I go away, hoping that I helped them focus on that obvious stuff.”
With the benefit of time, I now understand that focusing on the obvious things – the true top priorities – is one of the most important lessons that I learned from Porter. Another is the importance of organizing around the true top priorities. (I did get the chance to watch with amusement when Porter said to a classroom full of senior healthcare executives at a Harvard Business School course: “How you are organized really matters.” From my place in the back row, it looked like every one of them were writing in their notebooks, “How you are organized really matters… .”)
One of the key concepts that Porter brought to management was value chain analysis – identifying the key activities necessary to create value for your customer and giving those activities intense attention. Porter and I would later write about how value chain thinking helps managers give less attention to the issues that don't create value for their customers, such as internal politics, so they can focus on what does. And we would write about a strategic framework for creating value in healthcare, which I discuss later in this book.
In hindsight, I realize that he was taking me down a road to focusing on the creation of social capital. That road took me to my work as the chief medical officer of Press Ganey, and it took me to my role as the editor‐in‐chief of NEJM Catalyst, a publication we started to accelerate progress toward a high‐value healthcare system. (Porter co‐chaired the Editorial Board with me as we got it off the ground.)
And now that road has taken me to writing this book, which I hope will integrate the most important lessons that I have learned from colleagues inside and outside healthcare and from my ongoing work as a practicing physician. I feel fortunate to be functioning as a broker of the flow of information and insights from them to you. And one of those insights is that improvement is a social function.
Introduction
“I'm a chief officer for social capital.” That's the mindset I hope this book will instill in every reader. Being a CO for social capital means readers will approach building social capital in their part of the organization with the same intensity and discipline as their CFO brings to managing the organization's financial capital. Moreover, the evolution of managers of healthcare delivery into COs for social capital is critical to the effectiveness, viability, and success of their organizations.
The term social capital refers to the accumulation of resources people develop by connecting with one another. Building social capital is just as important as building financial capital – in fact, possibly more so. Just as financial capital is the money that enables organizations to do things they otherwise could not do, human capital is the people who enable organizations to do things they otherwise could not do. Social capital is how those people interact with each other and their infrastructure.
Organizations can borrow money from the outside. They can hire temporary help from agencies. But nothing can create trust, teamwork, and high reliability for organizations except the people within the organization.
At first glance, social capital may seem fuzzy – not something as real as money. After all, some of the currencies of social capital – terms like connectedness, respect, and trust – are often tossed around as aspirational flourishes, when in fact they are assets to be managed.
But anyone who delivers patient care knows that excellence is impossible without social capital. At the front lines, how you are organized really does matter. Teamwork really does matter. And you can't have good teams without team members who trust each other and who share values like respect, communication, and coordination.
Social capital is analogous to financial capital in important ways. Financial capital, more than its year‐to‐year operating margin, determines an organization's ability to construct new buildings, for example, or individuals' ability to pay tuitions or make large purchases. For individuals, wealth is driven more by their accumulated financial capital than their annual salaries. Like financial capital, social capital takes time to build, but the investment is worth the payoff.
As I argue in this book, the more social capital a healthcare organization accumulates, the stronger it becomes. Information flows throughout and among all levels of the organization. Employees – from support staff to caregivers to executives – become more engaged in their work and aligned with the organization's mission. Productivity increases, and the organization is able to become a “high reliability organization” – a designation reserved for “organizations that operate in complex, high‐hazard domains for extended periods without serious accidents or catastrophic failures” (Agency for Healthcare Research and Quality 2019).
If financial capital is the key determinant of wealth, social capital is the key determinant of resilience – the ability to withstand crises and recover quickly. Without resilience, healthcare organizations can founder and fail. Consider the harrowing story of Memorial Hospital in New Orleans, a safety‐net provider. When Hurricane Katrina struck in August 2005, unsafe conditions within the hospital and lack of an effective protocol to evacuate patients and staff resulted in the deaths of 45 patients. Ultimately, the hospital was forced to close.
In contrast, resilience stemming from social capital built up over years enabled Brigham and Women's Hospital to handle the tide of injured survivors streaming into the Emergency Department following the Boston Marathon Bombing of 2013. Over a few hours, 39 severely injured survivors poured into the Brigham's Emergency Department. Not one person died. The Emergency Department teams credited their success on training modified after the Navy Seal experiences of one of its leaders.
A few paragraphs from an extraordinary article in the New England Journal of Medicine described that day in detail:
For the next few hours, survivors continued to arrive. They kept coming.
Overall, we treated 39 survivors, ranging in age from 16 to 65 years. Nine patients required emergency operative intervention for open fractures, amputations, devascularized limbs, burns, and shrapnel removal. Many required second, third, and even fourth operations to wash out debris, remove dead tissue, stabilize fractures, and perform myocutaneous flap replacements of missing tissue. Some required vascular reconstructions, placement of external fixators, and fasciotomies of the legs.
These complex procedures took careful planning and coordination across all surgical disciplines. We also treated patients with less severe injuries, such as ear barotrauma and shallow shrapnel penetrations. These patients were invariably more concerned for the other victims than they were for themselves.
In these extraordinary circumstances, successful care came from colleagues working alongside familiar teammates, performing familiar tasks. When challenged, each team performed as if the situation were routine. In Boston, we fight like we train.
(Goralnick and Gates 2013, p. 1960)
The Brigham's response to the bombing didn't end after the injured were treated. In the ensuing week, the hospital faced numerous other challenges. Local police and federal agents stormed into the corridors as a “person of interest” in the bombing was treated for injuries. Loved ones of the seriously injured were accommodated as guests in empty patient rooms. Boston mayor Tom Menino, who was recovering from surgery in the hospital at the time of the bombing, set up a de facto City Hall in his room. First Lady Michelle Obama visited the injured, necessitating the engineering of a safe, private passageway for her entrance and exit. The communications team created a 24/7 media “command central” to update the press.
The weeklong crisis required an extra effort from every department of the hospital – from food services and housekeeping to caregivers to executive officers. In acknowledgment, a “BWH Strong” button was minted, and by the end of April, almost everyone who walked the halls was wearing one. The hospital also reconfigured an early May celebration – originally planned as a donor appreciation event associated with the hospital's centennial – into a celebration honoring those who helped save lives and supported each other during this difficult time.
How the Brigham responded to the Boston Marathon bombing is just one of many examples of how organizations with strong financial capital have weathered storms – sometimes literally. For example, Houston Methodist began a long‐term program to adopt the principles of a high‐reliability organization in order to improve quality and safety early in this century. Its leaders ultimately credited this work as helping it respond to a series of disasters in recent years, including tropical storms and the COVID‐19 pandemic (Phillips et al. 2021).
I acknowledge that some readers may have a negative reaction to the phrase social capital, because we haven't found a “conversion factor” to equate social good to financial interactions. I also sense the growing concern that the “financialization” of healthcare and the obsession with maximizing financial returns can lead to harm for patients and burnout among the people delivering healthcare – in effect eroding social capital.
However, financial concerns have always been important in healthcare, and likely always will be. Today, financial concerns are being amplified by medical progress and its associated costs, the rapid flow of information and money, and the evolution of organizations that can capitalize on those flows. To suggest that financialization can be stopped or reversed is not realistic.
What is realistic is to create an additional focus on social capital and to have this focus compete with financial concerns for the attention of leaders and boards of directors. Social capital enables organizations to do more and be better without adding more costs or people. Building social capital does require real work, however – the work of learning how to collaborate and thus to make the whole greater than the sum of its individual parts. It requires leadership at the top of organizations and disciplined management at the front lines.
The work is difficult. It is, in many ways, swimming against the tide of worrisome societal trends, like the erosion of trust and increasingly widespread social isolation. A vast array of data documenting these trends is summarized in Surgeon General Vivek Murthy's advisory from 2023, Our Epidemic of Loneliness and Isolation. Polls from the 1970s showed that about 45% of Americans felt that they could reliably trust other Americans; that proportion was just 30% in 2016. Other data show that the amount of time that people spend engaged with friends socially decreased from about 60 minutes per day in 2003 to 20 minutes per day in 2016, with the biggest decline in young people ages 15 to 24. This decline has been accompanied by a rise in mental health problems, and many experts, including Surgeon General Murthy, believe that online social network apps are worsening social capital, not building it.
Healthcare leaders talk more about finances than “softer” issues like the social capital of their workforce because money feels more tangible. But, as difficult as it may be to build social capital in this context, most leaders know that social capital leads to business success – especially in a field like healthcare, where teamwork is so critical and patients' needs are so variable.
An explicit goal of this book is to make social capital more tangible for managers in healthcare – to describe what social capital is and why it is important; to show how it is built and measured; to give case studies of examples of healthcare organizations that are building social capital; and to provide a playbook for how managers can approach social capital like their CFOs approach financial capital – by measuring it, analyzing the data, prioritizing opportunities for increasing it, making plans, and assessing progress on those plans.
This kind of work already goes on in most healthcare organizations, but the goal of this book is to make that work clearer and more effective.
Chapter 1A Primer on Social Capital
Let's start by defining what we mean by capital. A simple description is “anything that confers value or benefit to its owners” (Hargrave 2024). This definition makes one thing clear – capital is good to have, and having more is better than having less. Capital gives its owners an advantage – an edge in comparison not only with their competitors but also with their current selves. In other words, capital enables organizations to improve.
Differences in how organizations perform can often be explained by their access to various types of capital. If they have more
