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Reference: Cryptic connections illuminate pathogen transmission within community networks. Hoyt, Langwig, White, Kaarakka, Redell, Kurta, DePue, Scullon, Parise, Foster, Frick, Kilpatrick

This week’s paper of the week is brought to you by Dr Anant Jani, 3V Executive Director.

Bottom line (chosen from the paper)

We have shown that cryptic connections among groups and species have a key role in transmission dynamics and explain why transmission is far more intense in some species than others. Cryptic connections not only link social groups within species but also create bridges among species, resulting in highly connected communities

Implications for value improvement 

This very interesting paper looks at transmission of pathogens within and between different species of bats.  Hoyt et al.’s findings are consistent with Granovetter’s insights from his pioneering work on the strength of weak ties, with the strength of ties being characterised through factors including time spent together, intimacy, emotional intensity and reciprocal services (Granovetter, M.S. (1973). The Strength of Weak Ties. Am. J. Sociol. 78 (6): 1360–80).  Granovetto found that more people found jobs through weak ties as opposed to strong ties, suggesting that weak ties are a more effective channel for propagating novel information.

We can draw important parallels between Hoyt et al.’s experiments and Granovetto’s work – cryptic connections can be likened to weak ties and pathogen transmission can be likened to the transmission of ideas, both good and bad ideas. Using the general approach of addressing intra- and inter-species interactions as a way to characterise interactions within health and care systems there are a few ways we could apply Hoyt’s findings to health and care systems depending on how we define “species”:

  • Equating a species with an organisation (i.e. a GP practice, a hospital, county council, payer organisation like a CCG, patient group/charity), which would see us looking at the transmission of ideas between the different individuals within an organisation (intra-species interactions) or between organisations (inter-species interactions, including cryptic connections).
  • Equating a species with different types of actors within a healthcare system (e.g. a patient, a GP, a specialist, a manager, a finance professional, etc.), which would see us looking at the interaction of these different actors across organisational boundaries which could be facilitated by societies (e.g. patient groups/charities, the Royal Colleges – intra-species interactions) and between different types of actors and societies (inter-species interactions, including cryptic connections)
  • Equating a species with the different types of actors within an organisation (e.g. for a GP practice, looking at the GPs, practice nurses, allied health professionals, managers, etc. as different “species”), which would see us looking at the transmission of ideas between professionals of a given type within an organisation (intra-species interactions) and between different types of professionals within an organisation (inter-species interactions).

In the context of integrated care systems, we could see a justification for any of the above approaches to defining species and for each, we can show a link to the key findings of this study:

Social behaviour often constrains the transmission of pathogens, with network structure increasing transmission within social groups but limiting the spread to solitary individuals, other social groups, and between species. Contacts that bridge species and social groups are usually infrequent or indirect—for example, via the environment

Cryptic connections are important because they can determine whether transmission is constrained to single-species, local outbreaks or spans multiple populations and species. However, the extent of cryptic connections among social groups and their influence on pathogen dynamics is poorly known, in part, because of the difficulty in measuring these types of contacts…

The implications of Hoyt et al.’s paper are not necessarily novel in the field of networking theory but they are very important to remind ourselves of – cryptic connections, like weak ties, are difficult to predict and measure but, as evidenced by this study, are essential in linking different groups within and between species.

This is an essential lesson to keep in mind as we build integrated health and care systems and it is something we always keep in mind when we are working with our partners to help them design and build their Communities of Value (CoV).  We actively leverage non-cryptic connections and aim to create the conditions to foster cryptic connections with multiple stakeholders within and between different health and care system “species” to facilitate the rapid and effective dissemination of a new and positive culture focused on triple value and population healthcare.