News and Comment

The NHS – a social network?

Tuesday 6 December 2011


I realise it’s unusual to get excited about an academic article in a somewhat obscure scientific journal, but a recent piece of research about the evolution of cooperative behaviour caught my eye and got me thinking. (Please stick with me here!)

‘Cooperative behaviour cascades in human social networks,’ written by Fowler and Christakis in the Proceedings of the National Academy of Science, describes a set of laboratory experiments testing how people cooperate and behave towards each other while playing a series of public goods games. In these games individuals were asked to make contributions to a group; some of the experiments also included punishments.

Rather than individuals seeking to maximise their own gains and self-interest, game participants were found to copy the cooperative behaviour of others, creating what the researchers call a ‘behavioural cascade’. The effect was observed even though group members’ relationships were temporary and anonymous.

The research left me wondering whether the success of the government’s NHS reforms might depend more on creating this sense of the ‘group’ – especially the willingness of people to cooperate – rather than promoting competition. This perspective chimes with my own observations and recent experiences helping clinical leaders translate the NHS reforms into reality.

Whether setting up new organisations, building local alliances, or creating constructive relationships in line with new accountabilities, these activities require a fair amount of cooperation, for example, between clinical commissioning group leaders and their constituent GPs, across the partners of a fledgling health and well-being board, or between healthcare providers, patients and the public.

The intrinsic motivation of the people I work with is to improve health and patient care, yet they are troubled. The forces of destruction and reconstruction brought about by the reforms seem to stray far from what got them into this business in the first place. By and large, they are more interested in integrating care systems and improving patient experiences, and not creating a healthcare marketplace. In a way, what we have today is a largely uncontrolled experiment – a very large public goods game structured on competition between the NHS’s different parts.

Fowler and Christakis’s research drew some interesting conclusions about the role of social networks in structuring human interactions. Perhaps we need to consider the NHS as a social network – focusing on the people in it (including patients) rather than its structural components. Or maybe the NHS is a conglomerate of social networks. Either way, re-imagining the NHS in this way opens up new possibilities for improving patient care.

We can now begin to think about how government policy might be used to strengthen social networks and reward cooperation. Shifting the emphasis of NHS policy towards cooperation and encouraging the formation of strong networks may in fact prove more beneficial in the long run – not just for the people who work in the health service, but especially for the patients who use it.