Between-group behaviour in health care: gaps, edges, boundaries, disconnections, weak ties, spaces and holes. A systematic review

BACKGROUND: Gaps are typically regarded as a problem to be solved. People are stimulated to close or plug them. Researchers are moved to fill deficits in the literature in order to realise a more complete knowledge base, health authorities want to bridge policy-practice disconnections, managers to secure resources to remedy shortfalls between poor and idealised care, and clinicians to provide services to patients across the divides of organisational silos. Despite practical and policy work in many health systems to bridge gaps, it is valuable to study research examining them for the insights provided. Structural holes, spaces between social clusters and weak or absent ties represent fissures in networks, located in less densely populated parts of otherwise closely connected social structures. Such gaps are useful as they illustrate how communication potentially breaks down or interactivity fails. This paper discusses empirical and theoretical work on this phenomenon with the aim of analysing a specific exemplar, the structures of silos within health care organisations. METHODS: The research literature on social spaces, holes, gaps, boundaries and edges was searched systematically, and separated into health [n = 13] and non-health [n = 55] samples. The health literature was reviewed and synthesised in order to understand the circumstances between stakeholders and stakeholder groups that both provide threats to networked interactions and opportunities to strengthen the fabric of organisational and institutional inter-relationships. RESULTS: The research examples illuminate various network structure characteristics and group interactions. They explicate a range of opportunities for improved social and professional relations that understanding structural holes, social spaces and absent ties affords. A principal finding is that these kinds of gaps illustrate the conditions under which connections are strained or have been severed, where the limits of integration between groups occurs, the circumstances in which social spaces are or need to be negotiated and the way divides are bridged. The study's limitations are that it is bounded by the focus of attention and the search terms used and there is yet to be developed a probabilistic, predictive model for gaps and how to connect them. CONCLUSIONS: Gaps offer insights into social structures, and how real world behaviours of participants in workplaces, organisations and institutions are fragile. The paper highlights the circumstances in which network disjunctures and group divides manifest. Knowledge of these phenomenon provides opportunities for working out ways to improve health sector organisational communications, knowledge transmission and relationships.