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

Boundary spanners are effective at focusing on specific tasks (e.g. improving health careaccess or standards of care for specific patient group), and have been: ‘...used to develophub and spoke models of care. They can be innovative and flexible and cultivate appropriatemembership. Changes in individual professional attitude and practice might be achieved andthe commitment to an agreed integrated care pathway might be a tangible outcome’ (Harris,2005: n.p). In this respect, individuals forming the core of the network and who aresubsequently deeply embedded in the network structure are more inclined to keep their tiesestablished in comparison to those on the margins. The core-periphery structure of the wholenetwork provides a greater authority and hence more opportunities to engage (Cummingsand Higgins, 2006). Nonetheless, developmental networks include the complexity of thedecision making process for implementing new structures and innovation services: ‘Thewider the definition of their target group, the more difficult effective decision making. Thesenetworks often throw up conflicts between interests and priorities’ (Harris, 2005: n.p).2.2.1 Co-ordinating Networks and Individualistic Procurement NetworksHarris (2005) discusses two types of developmental networks: co-ordinating networks andindividualistic procurement networks. Co-ordinating networks (Sasieni et al., 1996, Goodwinet al., 2004, Bodenheimer, 2008, Gerwin, 2004) are a blend of enclave (See 2.3.4) andindividualistic networks. Gerwin (2004) explored new product development (NPD) andstrategic alliances, (the latter of which plays a commanding role in NPD within biotechnology),where exterior organisations often seek external artefacts including equipment,knowledge and risk sharing affiliates. Harris notes how an agent (individual/organisation)actively develops a body of members to achieve a certain task: ‘The experience ofbiotechnology firms is that their success depends on successful transfer of tacit knowledge inthe heads of experts and its entrepreneurial application, but that it does not work well througha classic managed hierarchical or individualistic network and requires this hybrid type’(Harris, 2005: n.p). These networks differ from enclaves in silo because there is a specifictask which emerged from a connection with other organisations which express a solidinterest in the task outcome. Network participants broadly understand the legitimacy of thisinterest and hence a form or accountability to an organisation ensues. ‘The task is usuallyeither focused on a hospital to deal with specialisation issues such as clinical standards oraccess, or is in the area of health and social care e.g. protocols, pathways of care’ (Harris,2005: n.p).Individualistic procurement networks are another sub-set of developmental networks which iseffectively a ‘coordinating network with procurement, commissioning or contracting role’(Harris, 2005: n.p). These networks are best developed in the US where health insurancehas driven contracting by integrated care networks. In essence, control of access toresources is: ‘...not originally in the hands of the host organisation as consumers exercisechoice and the network, by its relationships, facilitates greater organisational control over theresource, concentrating that choice in the way that the organisation prefers’ (Harris, 2005:n.p). Conversely, in conventional procurement networks, where multiple commodities aresourced through a common network of suppliers, ‘...allocating capacity appropriately amongthe several commodities assumes great importance in determining the profitability of theentire system’ (Chandrashekar and Narahari, 2011, in Agarwal and Ergun: p.2). Tensionsexist within individualistic procurement networks between consumer choice (Payment byResults) versus the force for integrated care partly through managed networks. In a nutshell:individualistic procurement networks are initially attractive to develop but have significant27