Brokerage-Centrality Conjugates for Multi-Level Organizational Field Networks: Toward a Blockchain Implementation to Enhance Coordination of Healthcare Delivery

A fragmented U.S. healthcare delivery system may reflect a highly brokered communication network controlled by only a few brokers. Such relational inequality in brokerage influences the formation of interorganizational brokerage relations. This chapter presents the theoretical mechanisms that underlie the reasoning of instantiating organizational power dynamics in controlling communication (brokerage) while increasing connectivity (degree centrality); determining opportunities for accessing and exchanging resources across subgroups; and shaping organizational decisions and actions that are transformed collectively into locally centralized or decentralized brokerage structures, called ‘brokerage-centrality conjugates.’ These conjugates make up the interorganizational collaboration network of an organizational field, and is tested and supported by multi-level exponential random graph models. Finally, a blockchain-based network intervention is proposed to enhance interorganizational communication and coordination to improve population health.