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Building bridges, breaking silos: The power of social capital to transform healthcare

The C-suite oversees all the major pillars of any organization. There’s a CFO to manage money, a CIO for technology, and, of course, a CEO to run it all.

Yet most C-suites ignore the factor that has the most effect on how their organization actually operates: social capital.

Social capital is the unifying theme that cuts across all the work we do in healthcare. It’s so important that it should have its own prominence in the C-suite. Or, more precisely, managers in every department and every role should own the responsibility of building social capital. They should act like they are CFOs for social capital.

What is social capital?

Social capital is even more important to your business than financial capital. Money can come from many places, but nobody but you and your team can create social capital—the teamwork, respect, engagement, and trust that determine how things will go.

Social capital is the value gained when people interact with each other and their infrastructure to do the important work of the organization—important work that they otherwise couldn’t do, and all the things that make a business thrive.

We create social capital every day as we work with patients, members, and our fellow employees. When doctors and nurses round together, that’s social capital. When teams huddle to discuss near-miss safety events, that’s social capital. When caregivers at the Mayo Clinic make a habit of putting their phones away as they walk through patient hallways, that’s social capital. When we strengthen belonging through shared experiences, like listening to Alicia Keys sing for essential workers at the height of the pandemic, that's social capital, too.

When I look at the stronger healthcare organizations in our country, I see social capital being actively cultivated and put into practice around the clock: fantastic teamwork, high reliability, pride in values, and a willingness to work across silos to share best practices and foster a culture of belonging.

Let’s look more closely at a few of these elements.


Every week, I walk into my primary care practice at Brigham and Women’s Hospital, say good morning to half a dozen colleagues in Area A, and put on my white coat. It’s good to be with the team.

In days past, we’d go down to radiology to look at X-rays together. No more: Today, we each pull them up on our own computer screens. What once was a group activity is now a solitary one.

Is it more efficient? In a sense, perhaps. Yet I never realized how many good things were happening when we were simply standing around together, waiting as a team for the elevator to radiology, pressing the button over and over even though it was already lit up. Those interactions built social capital day by day. They made providing care more fun—and, in turn, they made that care better.

When we feel ourselves working together toward a shared goal, that’s the social capital of teamwork.


Respect—the sense that your work is valued, that you’re important as a person, that you feel seen—is one of the most important forms of social capital. Respect is essential to building the trust among colleagues that grounds and facilitates all interactions.

Graph showing the relationship between workforce feelings of respect and patient experience scores

Caregivers feeling respected correlates with better experiences for patients.

This chart provides proof. Across the bottom, we see the range of how organizations perform in employees' sense of respect on the job, from the lowest scores to the highest. Along the left, we can see how patients rank their own experiences and how likely they’d be to recommend the hospital.

The stairsteps are almost exactly in sync. When the social capital of respect is high, patient experiences are better, and your organization is stronger.


The key elements of high reliability culture are currencies of social capital. Open communication, trust, and knowledge sharing—fueled by strong connections among caregivers—empower healthcare teams to learn, catch potential problems early, and deliver the safe, high-quality care each patient expects and deserves. Embedding habits, or universal skills and behaviors—and making them 100% routine—is the underpinning of high reliability organizing and a thriving healthcare system. 

Managers should focus on these positive behaviors for themselves and their teams. Treating humans like humans—and treating them with respect—is foundational to building social capital, as well as creating positive experiences. Even small rituals, like sitting next to a patient’s bed, should be as meaningful as the actions we apply to reach zero harm.

How to build social capital in healthcare

Ronald S. Burt’s book Brokerage and Closure describes two main paths to increasing social capital.

The first, brokerage, happens when you increase variation in your organization by nurturing new ideas and bringing in ideas from other places. It’s coming together as a healthcare community to ideate, innovate, and crowdsource solutions to common challenges—to think outside the box and solve big problems in better ways.

Brokerage is followed by closure. Having explored and experimented, you now reduce variation and converge on the best practices you’ve discovered. Maybe you have managers round on at least two direct reports a day, just the way clinicians round on patients. Or you implement a formal mentoring program, pairing experienced staff with newcomers to pass down knowledge and build relationships. You standardize around those actions that build high reliability, and hardwire values like trust, patient-centricity, and respect into our systems. Then you have the real foundation for social capital. 

It takes work. But the result is so worth it.

Moving forward

Let me go back to what I said earlier: Social capital should not be taken for granted, and it is far too important to leave it to a single person. Everybody on your team needs to be the head of social capital for the part they play at your organization.

Value for patients—in terms of better experiences and better health outcomes, with less friction—is always the overarching goal in any healthcare organization. Building social capital is the best path to that goal. Shall we meet at the elevator?

To discuss building social capital in healthcare further, reach out to the Press Ganey team

About the author

As Chief Medical Officer, Tom is responsible for developing clinical and operational strategies to help providers measure and improve the patient experience, with the overarching goals of reducing patient suffering and improving the value of care. Tom has more than three decades of experience in healthcare performance improvement as a practicing physician, a leader in provider organizations, researcher, and health policy expert. An internist and cardiologist, Tom continues to practice primary care at Brigham and Women’s Hospital in Boston.

Profile Photo of Thomas H. Lee, MD