Networks - a briefing paper for the Health Foundation - Centre for ...

1.2.3.2 Network StructuresNetwork structures can be fixed or endogenous (Young, 2006). Daugbjerg & Fawcett (2011)discuss the dissimilarity between power relationships on a state-society axis and interestintegration axis respectively. The former axis was referred to as forming the vertical powerrelations within a network and the latter as the horizontal power relations. It was reported thatnetworks that seek to formulate and implement public policy are typified by variation acrossthe two axes:The governance network school, with its primary interest in the changing nature ofstate-society relationships, has focused on the vertical axis. The policy networkanalysis school, with its interest in power relations between the various interestsaffected by the policy outcomes produced by a network, has focussed on thehorizontal axis. Neither school would reject the existence of either dimension ofpower but we would argue that each school does have a tendency to privilege oneaxis over the other (p.3).Slaughter (2004) also describes how network structures may be vertical and/or horizontal.The objective of vertical networks is the alignment of both national and supranational rules,norms and conventions via various modes of enforcement. Conversely, horizontal networksinextricably rely on knowledge and informational exchange in order to build capacity and alsoto construct and conform to global regulations and policies. A systematic literature review(Cunningham et al., 2011) noted how most studies used social network analysis to explorestructural relationships in networks. Structural network vulnerabilities were identified as smallgroups (including professionals) with special bonds who (perhaps) invariably exclude others,and over-reliance on centric agencies and/or specific individuals. Cunningham andcolleagues concluded that the most effective healthcare networks contain structuralcharacteristics including intermediaries, interpersonal bridges, social capital, trust, densityand centrality. Networks are articulated through their relationships and core roles andfunctions, rather than their structure per se (Mendizabal, 2006b): ‘Networks can take manyforms to deliver similar functions, depending on a broad range of factors. To determine anetwork’s capacity to deliver its functions, we should ask whether its structure is the mostappropriate one’ (Mendizabal and Hearn, 2011: p.19).Ferlie described how some healthcare functions in Scotland and Wales are outsourced tosecond and third sector providers such as long-term residential care and elective surgery.These functions are subject to appraisal and regulation but not vertical line management(Ferlie et al., 2010). Research is increasingly focusing on: ‘...collaborative work acrossdisciplines and organisations in accelerating implementation of best practices along thecontinuum of care, and how e-technologies influence access, sharing, creation, andapplication of knowledge’ (Poissant et al., 2010). Studies have explored structure andchange in child mental health service delivery networks (Johnsen et al., 1996). Johnsen andcolleagues found that, from a structural standpoint, two similar networks that originated atdifferent levels of systems development will evolve in a relatively similar manner over time(Johnsen et al., 1996). Most studies from the aforementioned systematic literature review byCunningham identified the characteristics of a network structure connected with betterperformance. Persisting success factors relate to understanding the network'scharacteristics, ensuring its smooth functioning and taking frequent steps to facilitate itsimprovement. Nonetheless, they conclude that precious time spent on nurturing networkdevelopment does not automatically equate with patient improvement. They note how17