Case: The Hidden Network That Transformed A Healthcare System

How Social Networks Revealed—and Resolved—Hidden Performance Gaps

Executive Summary: Organizations today are struggling to engage their workforces and reach their strategic potential. In this article, we look into a recent case with a growing healthcare firm where we leveraged network analysis and behavioral economic thinking to improve knowledge sharing, drive innovation, and improve operational efficiency.

I. The Problem

Over two decades, a healthcare provider specializing in care for medically fragile children expanded from a single location to a six-site operation across multiple states. As the organization grew, so did the complexity of maintaining a patient-centred-centered model. While outcomes were relatively consistent, operational processes varied widely. Some teams operated with high efficiency; others took longer, duplicated tasks, or missed opportunities for streamlining. Financial and operational data showed the differences, but the underlying causes—and solutions—remained unclear.

What drove this inconsistency? Small-scale—or "little i"—innovations were happening in everyday moments. Individual nurses were adapting and improving their processes—but because these insights were confined to their immediate environments, they weren’t spreading. Formal cross-functional teams existed, and they met regularly. But true knowledge flow wasn’t happening in the meeting room. It was happening on site—in the “watercooler” conversations that shape the informal network.

II. The Approach: Using Organizational Network Analysis (ONA)

To uncover how communication truly flowed, the organization partnered with us to conduct an Organizational Network Analysis (ONA). This methodology reveals not just who reports to whom, but who talks to whom—who shares information, seeks advice, and influences others.

Drawing on the insights of Rob Cross and Andrew Parker, authors of The Hidden Power of Social Networks, we mapped communication patterns at both the site level and the individual level. The results confirmed what many suspected but couldn’t measure: real influence and knowledge-sharing weren’t following formal structures.

Instead, critical communication was happening informally. And a handful of individuals—regardless of their formal title—were the true hubs of knowledge sharing. As Ronald Burt describes in Structural Holes, these brokers were essential to bridging gaps between disconnected parts of the organization.

Figure 1. Pre-Intervention Communication Network at the Individual Level

This network graph visualizes communication among individual nurses across six sites before the intervention. Each dot represents a staff member, and each line reflects informal communication ties—sharing advice, solving problems, or exchanging best practices. The fragmented structure and isolated clusters reveal that knowledge was not diffusing effectively across the system, limiting the spread of local innovations.

III. The Insights

ONA revealed two significant patterns:

• Innovation Hubs: Some locations, typically anchored by highly connected nurses, became centers of effective and efficient practice. These teams weren’t just better resourced—they were better connected.

• Disconnected Islands: Other sites, despite access to the same resources, operated on the edge of the network. Their local innovations stayed local, and their processes lagged as a result.

At the individual level, the pre-intervention network was sparse. The average nurse connected with just over two others. The organization had 18 separate, unconnected communication clusters, and there was little cohesion or spread of best practices.

Most importantly, the analysis showed that innovation isn’t just about what you know—it’s about who trusts you enough to listen. Knowledge couldn’t travel unless relationships existed to carry it.

IV. The Intervention

To close the gap between innovation and adoption, the organization designed a set of interventions to connect the informal network to the formal structure.

Key influencers from high-performing sites were identified and asked to mentor peers at more isolated locations. These relationships were supported through site visits, 1:1 mentoring, and roundtable discussions designed to create trust and accelerate knowledge-sharing.

“3Fold's approach uncovered a hidden path. By identifying and empowering the natural influencers within our organization, we were able to leverage our trust ecosystem to streamline information-sharing and team integration. Our sites are now more interconnected than ever.”
— Dick W., Chief Operating Officer

The goal was simple but powerful: enable great ideas to travel farther by strengthening the relationships that carried them.

Figure 2. Post-Intervention (6 months) Communication Network at the Individual Level

This network graph illustrates how informal communication patterns changed after the intervention (6 months). Compared to the pre-intervention map, the network is more interconnected, with fewer isolated clusters and more robust cross-site communication. Each dot represents a staff member, and lines indicate informal ties. The visual shift reflects a stronger, more “vibrant” network that supports faster, more consistent knowledge sharing across the organization.

V. The Outcomes

The impact was swift. Over the six months between the pre- and post-intervention assessments:

• Communication Volume and Quality Increased: At the individual level, the average weighted degree—a measure of communication richness—surged from 33.86 to 82.45.

• Greater Network Cohesion: Disconnected groups dropped from 18 to 12, and clustering (team-level collaboration) nearly doubled.

• Stronger Peer-to-Peer Ties: The average degree increased by 32%, meaning knowledge and influence spread to more people.

• System Resilience Improved: The network no longer depended on a few key players. Redundant, distributed connections created continuity.

“Within months, critical information-sharing improved noticeably, directly enhancing patient outcomes across all locations.”
— Jody R., President

At the site level, communication intensity between locations rose by nearly 45%, while maintaining full connectivity. Every facility could now share and receive knowledge rapidly, bypassing the need for headquarters to act as a bottleneck.

Notably, once the informal network was reconnected, novel ideas began to spread organically throughout the organization. By the end of six months, both formal and informal processes began to converge across sites, reducing inefficiencies (i.e., costs) and aligning culture.

Secondary benefits followed:

• Diffusion of Key Person Risk: Previously, critical knowledge was concentrated in individuals at headquarters or specific locations. Now, that knowledge was shared.

• A Rising Tide Effect: As innovations spread, all sites improved. No single site was left behind.

Figure 3. Communication Network at the Site Level: Before and After (6 months)

This side-by-side comparison illustrates how site-level communication evolved through the intervention. While the number of connections between locations remained the same, the strength and richness of those connections increased significantly. Larger node sizes represent greater centrality and influence, while thicker lines indicate higher communication intensity. This rising tide effect reflects how all sites became more connected and capable—elevating collective performance across the organization

Sidebar: How The Network Evolved

VI. Lessons for Other Organizations

This experience offered key lessons that apply far beyond healthcare:

• Design for Networks, Not Just Structures: Org charts don’t show how value moves. Informal relationships do.

• Empower Connectors: As Burt and Cross have shown, brokers and influencers drive adaptation and innovation. Find them. Support them.

• Resilience Comes from Redundancy: Robust systems don’t rely on single points of failure. Build overlapping communication paths.

• Relationships Drive Knowledge Transfer: Morten Hansen’s research shows that information spreads through trust. Strengthen relationships, and knowledge will follow.

These lessons scale well across industries—because every organization has a hidden network waiting to be unlocked.

VII. Conclusion

We started with process inconsistencies and ended with a network-wide shift in how knowledge moved through the organization. By uncovering and strengthening informal communication patterns, the company enabled critical innovations to spread, improved efficiency, and created a stronger, more unified culture.

At 3Fold Collective, we help organizations uncover and activate the power of their hidden networks. Because sometimes the solution to your biggest challenge isn’t a new strategy—it’s recognizing the people already solving the problem and giving them a voice.

References

Burt, R. S. (1992). Structural holes: The social structure of competition. Harvard University Press.

Cross, R., & Parker, A. (2004). The hidden power of social networks: Understanding how work really gets done in organizations. Harvard Business Review Press.

Hansen, M. T. (1999). The search-transfer problem: The role of weak ties in sharing knowledge across organization subunits. Administrative Science Quarterly, 44(1), 82–111. https://doi.org/10.2307/2667032

Krackhardt, D. (1992). The strength of strong ties: The importance of philos in organizations. In N. Nohria & R. G. Eccles (Eds.), Networks and organizations: Structure, form, and action (pp. 216–239). Harvard Business School Press.

*Since you’re still here, you may be interested in reading the origin story of organizational network analysis and its modern-day applications, like in the above case. In the below story, I take you back to the 18th century to witness the creation of graph theory, the integration of archeology and psychology in the 20th century, and the modern-day social and organizational implications. You can find it here on the 3Fold Outcomes Substack: