White Paper: Organic and Artificial Bridging in Agile Science for Healthcare Innovation

Agile science, a methodology focusing on understanding and steering real-world behaviors, plays a crucial role in healthcare innovation (Boustani, Holden, Azar, & Solid, 2020). This white paper delves into the concepts of organic and artificial bridging within Agile Science, exploring how these approaches impact the diffusion of innovation, particularly in healthcare delivery systems.

Agile Science in Healthcare:

Healthcare systems are complex adaptive networks (CANs), comprised of interconnected individuals with unique perspectives, decisions, and behaviors (Boustani et al, 2023). Agile methodologies prioritize interprofessional teamwork and value interactions over processes and tools (Azar, Glantz, Solid, Holden, & Boustani, 2023). The agile mindset promotes problem understanding through sprints – short, focused periods where actions are taken, and data are collected for iterative adjustments (Azar et al, 2023).

Agile Science, with its eight-step methodology, provides a structured approach to addressing healthcare challenges (Boustani et al, 2023). For example, in a community healthcare setting, a significant concern arises regarding patient empanelment. The center faces a high turnover among Primary Care Providers (PCPs), lacking an effective process for reassigning patients when PCPs depart. This situation can lead to gaps in care, emphasizing the critical role of empanelment in continuity of care and population health management.

Agile Implementation Process:

1.  Identify Opportunity:

Recognize the issue of low-performing patient empanelment and its potential impact on care continuity.

2.  Identify Evidence-Based Solutions:

Conduct comprehensive research in healthcare academic journals to identify evidence-based solutions addressing patient empanelment challenges.

3.  Develop Evaluation and Termination Plan:

Create a termination plan outlining goals, objectives, and metrics to assess the effectiveness of the agile implementation process for patient empanelment.

4.  Assemble Team:

Form a dedicated team, including agile scientists and other relevant stakeholders, to collaboratively address patient empanelment.

5.  Perform Implementation Sprints:

Execute rapid cycle sprints, consistently evaluating and adjusting the patient empanelment process based on the termination plan.

6.  Monitor Implementation Performance:

Continuously assess the performance of the patient empanelment rapid cycle sprints, ensuring alignment with established goals.

7.  Monitor System Performance:

Evaluate the broader impact of the patient empanelment process on the entire healthcare system, identifying systemic improvements.

8.  Develop a Minimally Standard Operating Procedure:

Based on the success of the agile sprint, draft a minimally standard operating procedure for patient empanelment, ensuring sustained improvements.

In applying agile science to the patient empanelment scenario, the methodology proves instrumental in addressing challenges, fostering a proactive approach to care, and promoting continuous improvement within the healthcare setting. This scenario exemplifies the practical application of the eight steps of agile science.

Diffusion Challenges:

Despite successful identification of solutions through sprints, the challenge lies in diffusing these innovations throughout healthcare organizations. Dr. Damon Centola's research emphasizes the importance of strong ties and wide bridges in creating social norms to facilitate diffusion effectively (Centola, 2015).

 Organic vs. Artificial Bridging:

This paper introduces the concepts of organic and artificial bridging. Organic refers to the natural and authentic formation of both weak ties/narrow bridges and strong ties/wide bridges (Centola, 2015). However, when fostering a social norm, strong ties and wide bridges prove more effective (Centola, 2015). To intentionally accelerate their formation, I hypothesize that artificial bridging becomes necessary.

The Fishing Net Method:

Dr. Centola writes that the fishing net method is the best approach for fostering a social norm (Centola, 2015). It involves consistent and repeated information reinforcement to create a social norm. Strong ties and wide bridges, formed organically, require contact with multiple sources for behavior adoption (Centola, 2015). This clustered network approach, rich in redundant ties, facilitates the diffusion of behaviors across large populations (Centola, 2015).

The Role of Artificial Bridging:

While both organic and artificial bridging serve the purpose of diffusing information, the distinction lies in their effectiveness in fostering social norms (Centola, 2015). Artificial bridging becomes imperative when the natural process is insufficient to rapidly accelerate strong ties and wide bridges, ensuring the swift establishment and adherence to social norms.

Intentional Use of Artificial Bridging:

To intentionally use artificial bridging to foster a social norm, agile scientists leading innovation change initiatives must possess an agile mindset (Boustani et al, 2023). They should leverage psychological safety and intentionally foster relationships within or between healthcare organizations (Boustani et al, 2023). Connecting teams, such as the strategy team, quality improvement (QI) team, human resources team (including organizational development and human resources business partners), patient safety team, and care transitional team, fosters a social norm. Refer to Diagram 1.

Diagram 1: Fostering social norms by intentionally creating strong ties and wide bridges.

Example Agile Diffusion Application Using Artificial Bridging for Healthcare and Non-Healthcare Consultants. This example outlines a strategy for using Artificial Bridges to engage healthcare consultants on social media and influence their registration for a 5-day Agile Science Bootcamp. By employing the fishing net communication pattern, the method focuses on identifying key influencers, building strong ties, and creating wide bridges across networks to drive behavior change.

This example illustrates the proposed steps for diffusing agile science, showcasing how the principles of organic and artificial bridging can be applied to both healthcare and non-healthcare consultancy practices.

Table 1: Steps for Fostering Strong Ties and Wide Bridges using Artificial Bridging for Agile Science Diffusion

By following this systematic example, targeted healthcare consultants should register for the 5-day Agile Science Bootcamp, learn Agile Science, and spread the information in their healthcare organizations. Healthcare consultants should began strategically foster strong ties and wide bridges using artificial bridging, accelerating the diffusion of agile science. This, in turn, facilitates the creation of a social norm around agile practices, leading to sustained improvements and innovative transformations in both healthcare and non-healthcare sectors. 

Conclusion:

In the realm of Agile Science, the concepts of organic and artificial bridging add a nuanced layer to the diffusion of healthcare innovations. By understanding the dynamics of natural and intentional networking, healthcare organizations can strategically leverage these approaches to drive the successful adoption of innovative solutions and foster a culture of continuous improvement.

References

Azar, J., Glantz, E., Solid, C., Holden, R., & Boustani, M. (2023). Using Agile Science for Rapid Innovation and Implementation of a New Care Model. Frontiers of Health Services Management, 40(2), 22-27.

Boustani, M., R. J. Holden, J. Azar, and C. A. Solid. 2020. The Agile Network: A Model to Foster Innovation, Implementation, and Diffusion in Healthcare Settings. St. Paul, MN: Beaver’s Pond Press.

Centola, Damon. 2015. The Social Origins of Networks and Diffusion. American Journal of Sociology. 120 (5): 1295–1338.

Shadbolt, E., Paulson, M., Divine, L. T., Ellis, J., Myers, L., Mucks, K., ... & Lindroth, H. (2022). Increasing Hospital at Home Enrollment Through Decentralization With Agile Science. The Journal for Healthcare Quality (JHQ), 10-1097.