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

3.2. How Organisations Function as Units in Networks and IntegrativeGovernanceThe NHS has a tendency to regress towards linear solutions to complex problems that arisewithin healthcare (Keasey et al., 2009). The under-researched area of network management(perhaps because network management is an oxymoron in all but the hierarchical types) isparticularly relevant in complex networks that tackle wicked issues which involve first, secondand third sector agents (Klijn E.H. et al., 2010). Network Governance was discussed in abriefing paper (NHS Service Delivery and Organisation R&D Programme., 2005), whichnoted how all regulators beyond the boundaries of a network faced similar challengesassociated with authority (to enforce power). Addressing the governance gap requiresincentives (when associated with individual networks), or developing pre-formed and sharedprinciples, within enclave networks, to enable participant members to adhere to a system ofself-regulation and subsequent governance (NHS Service Delivery and Organisation R&DProgramme., 2005). Research has largely focused on the structural components of healthnetworks (Provan and Kenis, 2008), however more recent studies have expanded this unit ofanalysis to gauge the dynamics of network emergence that cumulate in the outcomes ofprocess improvement interventions (Papadopoulos et al., 2011).Papadopoulos and colleagues drew upon the conceptual and analytical framework of ActorNetwork Theory (Latour, 1996) to trace how stakeholders change work roles and networkallegiances over time. Klijn (Klijn, 2008) illuminates North American and Europeanapproaches to public networks, and suggests that future studies should focus on greaterlevels of integration. Mendizabal cited the lack of investment in the central communitybuilding function where participant members often engage with the network secretariat in aservice-to-provider capacity, ‘...but do not deal with each other. This threatens thesustainability, as well as the effective fulfilment, of the network’s roles’ (2008: n.p). In somecases, networks actually compete for funding and policy influence with their fellow members,however Mendizabal cautions against viewing networks as mere funding mechanisms perse. Networks that are grounded in the use of contracts (eg via a care pathway) may perhapsengender compliance, however these networks are less successful in integrating careprovision than the more managed networks or singular organisations, and: ‘Governmenttargets, audit and incentive arrangements need to be harmonised to promote and rewardworking in networks (NHS Service Delivery and Organisation R&D Programme., 2005: p.3).Future studies must broaden their unit of analysis from mere descriptions of networkedactivities and human behaviours, to how organisations function as units within networks. Thisrequires an intricate analysis of whole networks, including their governance structures (howthey are governed) (Provan et al., 2007, Provan and Kenis, 2008). Rosen et al (2011)explored four organisations in the USA (2), UK (1) and Holland (1) notable for providingeminent and cost-effective integrated care. It was reported that their knowledge andexperience of integrating health and social care services illuminated six operational actions(integrative processes) to be enacted in network development (beyond mere structures), thatcan help to support incentives and manage healthcare delivery across team andorganisational boundaries.Organisational processes in the form of governance arrangements betweenparticipating organisations which: ‘...encompass: the relationships betweenorganisations, such as partnership; structural integration through merger or39