Social ties between team members affect patient satisfaction: a data-driven approach to handling complex network analyses

  • Betina Ristorp AndersenEmail author
  • Jesper Løve Hinrich
  • Maria Birkvad Rasmussen
  • Sune Lehmann
  • Charlotte Ringsted
  • Ellen Løkkegaard
  • Martin G. Tolsgaard


Research from outside the medical field suggests that social ties between team-members influence knowledge sharing, improve coordination, and facilitate task completion. However, the relative importance of social ties among team-members for patient satisfaction remains unknown. In this study, we explored the association between social ties within emergency teams performing simulated caesarean sections (CS) and patient-actor satisfaction. Two hundred seventy-two participants were allocated to 33 teams performing two emergency CSs in a simulated setting. We collected data on social ties between team-members, measured as affective, personal and professional ties. Ties were rated on 5-point Likert scales. In addition, participants’ clinical experience, demographic data and their knowledge about team members’ roles were surveyed. Perceived patient satisfaction was measured on a 5-point Likert scale. Data was analysed with a linear regression model using elastic net regularization. In total, 109 predictor variables were analysed including 84 related to social ties and 25 related to clinical experience, demographics and knowledge test scores. Of the 84 variables reflecting social ties, 34 (41%) had significant association with patient satisfaction, p < 0.01. By contrast, a significant association with patient satisfaction was found for only one (4%) of the 25 variables reflecting clinical experience, demographics and knowledge of team roles. Affective ties and personal ties were found to be far more important predictors in the statistical model than professional ties and predictors relating to clinical experience. Social ties between emergency team members may be important predictors of patient satisfaction. The results from this study help to enhance our conceptual understanding of social ties and their implications for team-dynamics. Our study challenges existing views of team-performance by placing emphasis on achieving collective competence through affective and personal social ties, rather than focusing on traditional measures of expertise.


Social ties Patient satisfaction Education Simulation 



We thank the staff at the department of Gynaecology and Obstetrics and the Department of Anaesthetics/Operating room for their participation. Especially thank to the steering group: Midwives Mette Lise Buchwald, anaesthetic specialist Agnieszka Huscher, Andrea Kisling, Bjørn Dehlie, Pernille Bækgaard and scrub nurse Margrethe Klaaborg.

Author contribution

BRA contributed to the conception and design of the work, and to data acquisition and interpretation, data analysis and drafted the paper. MT and MBR contributed to the conception and design of the work and to data acquisition and interpretation, data analysis and assisted in drafting the paper. EL contributed to the conception and design of the work and to data acquisition and interpretation and assisted in drafting the paper. JLH and SL contributed to data analysis and interpretation and assisted in drafting of the paper. CR contributed to the conception and design of the work and assisted in drafting the paper. All authors contributed to the critical revision of the paper and approved the final manuscript for publication. All authors have agreed to be accountable for all aspects of the work.


The project was funded by the Danish foundation TrygFonden.

Compliance with ethical standards

Conflict of interest

All authors have declare that they have no conflict of interest.

Ethics approval

The study was reported to the Danish Patient Safety Authority (3-3013-1732/1) and approved. Data was reported to the Danish data protection agency (NOH-2015-040. I-Suite: 04287).


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of Gynaecology and Obstetrics, North Zealand HospitalUniversity of CopenhagenHillerødDenmark
  2. 2.Copenhagen Academy of Medical Education and Simulation, Capital Region of Denmark2100 CopenhagenDenmark
  3. 3.Cognitive Systems, Department of Applied Mathematics and Computer ScienceTechnical University of DenmarkLyngbyDenmark
  4. 4.Department of Gynaecology and Obstetrics, Hvidovre HospitalUniversity of Copenhagen2650 HvidovreDenmark
  5. 5.Center for Health Science Education, Faculty of HealthAarhus UniversityAarhusDenmark
  6. 6.Department of Gynaecology and Obstetrics, RigshospitaletUniversity of CopenhagenCopenhagenDenmark

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