Professional Networks and the Diffusion of Medical Technologies: An Empirical Study on Robotic Surgery

The advancement of knowledge and the availability of new technologies in health care deeply influence patients’ length and quality of life. Current health care systems have thus re-organized services provided in order to select effective solutions and to the increasing demand of more complex and costly services. Such need frequently implies a re-orientation of health care organizations and providers. Given that the real success of a specific technology is measured by its use in clinical practice, the exploration of those factors affecting the adoption and use of innovations seems to be convenient. Particularly, a number of information is considered in the decision making process of clinicians: the mindlines, namely tacit and informal knowledge and the clinical guidelines. This chapter presents and discusses retrospectively these dynamics in the Italian National Health Care Service (I-NHS) with regard of an innovative surgical system, the Da Vinci Robot, which is a minimally invasive surgical system receiving great organizational and managerial interest. The objective of the study is to understand the role of informational determinants, both mindlines and guidelines, in the temporal choice of adoption of the technology by the Italian adopters. A semi-structured questionnaire was built and submitted to surgeons in order to collect information about the usage of the technology, the advice network of professionals and the sources of information accessed to determine the choice of adoption of the technology. At the end of the administration period, twenty-eight adopters fully answered to the questionnaire. Social Network Analysis (SNA) techniques were used to analyze the advice inter-physician networks and pseudonetwork measures were used to identify degree of similarity/difference between each pair of surgeons involved in the study. Multiple regression quadratic assignment procedures (MRQAP) were run to test the statistical association among our dependent variable (temporal difference in the adoption of the surgical system) and the different sources of information selected in the study both guidelines and the mindlines. We found a significant and positive effect of the extent to which two individuals used guidelines such as evidence based medicine (EBM) documents and information to discover for the first time about the technology on their subsequent adoption. In other words, the greater the number of same sources used, the smaller the distance in term of months in the adoption of the new technology. Overall, we confirm the importance of sharing the same formal sources of information (guidelines) above and beyond individual’s informal network (mindlines) in affecting the similarity in the temporal choice of adoption of the technology. Our study contributes with original evidence to understand the adoption process of a new technology in health care, providing new insights about how beliefs and values about the technology are created and concur to define the temporal choice of adoption. Contrarily to what stated in previous research, we elicit the prominent role of different formal informational sources (EBM) in determining the final judgment toward technological change in health care and in controlling the uncertainty of highly innovative technologies.