Can social capital fix healthcare's patient safety problems?

What is social capital, and what does it mean for healthcare?

Healthcare leaders can think of social capital as a key tool to leverage better healthcare outcomes by way of human interaction.

"Capital is anything that gives you an advantage," Lee explained.

Financial capital, or money, lets you acquire equipment, and human capital, or employees, lets you leverage another's skills.

"Social capital is how people work together and with their infrastructure that enables them to do things they couldn't otherwise do," Lee said. "We're living in a time in healthcare where financial capital is constrained, and human capital is constrained. And so, we have to hit it out of the park on social capital."

Clinical leaders, managers and directors are in charge of building social capital across their teams, harnessing the power of social networks and making them great.

They can start at the most fundamental level: identifying where the connection doesn't exist or is weak and fortifying that. Through human connection, leaders can work on strengthening bonds between clinical team members, increasing the power of the social networking. People won't want to lose their bonds, Lee reasoned, creating opportunities for positive peer pressure.

Because ultimately, the goal of social capital is to use those connections to transmit desirable goals and values. In healthcare, this can mean the value of promoting a culture of patient safety or equity and inclusion. Managers who have built a lot of social capital will be able to leverage the connections between team members to create a mechanism of positive peer pressure to uphold those values.

Building social capital on the healthcare team

Indeed, building social capital on a healthcare team isn't a stepwise approach. Rather, it's the synergy of good management, strong interpersonal bonds and a shared North Star. Usually, that North Star or group goal will be self-evident, like a better culture of safety or respect. However, it's incumbent upon the team's manager or director to identify and define that goal.

Clinical leadership won't find a step-by-step roadmap to social capital, but there are a few best practices that can lead to those positive dynamics, according to Lee.

For starters, clinician managers need to build social capital the way a CFO would build financial capital, Lee stressed.

"A CFO looks at data and understands where things are not going well and then addresses them," he explained. "To build social capital, leaders should do the same. If you find that your culture of respect could get better -- and it's true virtually everywhere that it could get better -- then do something about it."

Clinician managers will get that data by regular rounding with their reports.

"Every manager should be rounding on two of the people reporting to them every day, and not the same two people," Lee advised.

These interactions need to be meaningful and filled with both yes-or-no and open-ended questions. Leaders should ensure they touch on topics that are important to their reports and assess how they connect those areas to the team's overall North Star.

This gives managers the ability to track group sentiment and pull social levers as necessary to drive cohesion. With everyone invested in the same North Star, social capital can begin to flourish and social enforcement mechanisms, like positive peer pressure, can function.

Take the example from Mayo that Lee offered up. No one mentioned to Lee any explicit enforcement mechanisms for answering a clinical page. Instead, the healthcare system has a culture that calls for providers to immediately address clinical pages. You might not lose your job if a page goes unanswered, but you will be socially isolated.

"You just don't want people saying you're the kind of person who doesn't answer a page," Lee recalled his colleagues telling him.

That type of enforcement mechanism, the social capital, is more effective than a punitive enforcement mechanism because it helps employees buy into a system for positive change, Lee insisted. And that has positive ripple effects across the healthcare system, including for the patient experience.

Translating teamwork to the patient experience

Building social capital is essential to better clinical teamwork, which data has shown has a positive impact on the patient experience.

"It will not shock you to know that where the employees are working better together patients think the care is better and they feel more confident and trusting in it," Lee reported.

In 2023, Press Ganey published "The State of Employee Engagement" and found that better healthcare employee engagement was linked to better patient safety and better patient experiences. According to Lee, that's largely because patients are smart about sensing when their encounter isn't going well and when there is bad cohesion among the care team.

The proof might be in the pudding, but Lee contended that you don't need data to know that this is true. It's intuitive that better employee engagement and teamwork means a better patient experience.

"Patients, doctors, nurses, employees -- they actually all want the same thing," he concluded. "They all want care to feel safe. They all want teamwork to be good. When the teamwork is good, the caregivers are happier and they want to stay employed. The patients want good teamwork too."

Sara Heath has covered news related to patient engagement and health equity since 2015.