Table 1 Key concepts of a network approach: from awareness toward action in primary healthcare

1

Strength of weak ties

• The extent of weak ties between groups are important for leveraging (a) new knowledge from other areas, networks, sectors, and disciplines; and (b) to provide strategies and opportunities for advancing social and career relationships (bridging ties).

• Explicit recognition of the value of weak ties (acquaintances and contacts) as a key to knowledge flow, diffusion and research uptake.

• Workplaces can benefit from actively facilitating opportunities for staff to explore a range of contacts in order to address work related issues.

Strong interlocking ties

• Important to consider the extent and nature of close (strong bonding) interlocking ties that may exist within and across the networks. These ties serve to replicate practice, sustain an ingrown system, and preserve structural and procedural status quo norms.

• An individual's position in the networks influences their capacity to access resources (e.g., information) to do their job.

• Critically review the impact on practitioners and patient populations when strong bonding ties are more common in primary care networks than weaker ties.

• Instigate strategies to mitigate exclusion of those who are sanctioned because they challenge group norms.

2

Cross-cutting ties

• Weaker connections represent holes in the structures which act as buffers to insulate networks and protect professional specializations.

• Health system reform is predicated upon inter-connected teams, knowledge and technology for change, so links through the structural holes are imperative for a better health system.

• These diverse ties are important for leveraging resources from powerful individuals and institutions (linking ties).

• While acknowledging that natural ties exist between individuals (e.g., team and disciplinary specialization), it is important to foster cooperative relational ties to diffuse new knowledge. One strategy is to support individuals who have 'weaker connections' that enable them to broker knowledge and influence change in boundary spanning roles across the networks.

• It is timely to mentor these individuals and identify what sort of support they require to be effective in the structural holes.

• Complexity theory provides useful insights into change and adoption of new practices and research-based knowledge.

3

Structural equivalence/status

• Ties that exist between individuals with similar characteristics and affiliations.

• Important for brokering new ideas and research knowledge/evidence.

• Supporting opinion leaders would be a strategy to introduce new practice and foster support for individuals in an organizational climate of constant change.

• Adopting new practice, foster and sustain buy-in across disciplines – teamwork will increase knowledge exchange.