Networks have become a prominent template for public service governance. Often seen as an alternative to hierarchies and contracts, networks cross institutionalized organizational or sectoral boundaries to promote collaboration and the sharing of resources when addressing complex problems. Nowhere is this more the case than in the field of health services modernization and improvement.
Comprising unique empirical contributions, drawn primarily from the experience of the UK National Health Service (NHS), this edited collection develops a ‘decentred’ analysis of health and care networks. Contributors look beyond particular structures or patterns of governance and focus instead on the interpretation of the meaningful practices of policy actors as they encounter and enact policy instruments and structures. The approach offers a distinct form of analysis that deepens and enriches more traditional public policy accounts of network governance. It recognizes the influence of local history, highlights the influence of dominant economic, technical and corporate narratives, and acknowledges the continued influence of biomedical knowledge and professional expertise.
Offering practical insight for current and future service leaders about the challenges of implementing, managing and working within networks, this book draws out key messages for practitioners and researchers alike.
1. Decentering Health and Care Networks: An introduction
This chapter will introduce the collection by first setting on the historical policy context of networks and network governance in public policy and health policy. It will then introduce the principles of a decentred approach, focusing in particular in the interplay between history, dilemma and situated agency, and the concepts of narrative and discourse. After demonstrating the application of these ideas to health policy developments, in general, and health networks, in particular, the chapter will summarise the themes of the collection as contained within each contributing chapter, and will distil the cross-cutting themes, resulting in a summary statement of the main theoretical, empirical and practical contributions from the collection. This include, for instance, the importance of the temporal and spatial dimensions of networks, the persistence of resistance within and between networks, and the significance of framing, branding and badging networked activities.
Mark Bevir, University of California, Berkeley
Justin Waring, University of Nottingham
2. Putting Network Governance in its Place; locating the projects of integrated health and social care
As an approach to health service organisation resting on network ideals, integrated care has been widely adopted as an ideal in health service reforms. However, in promoting a vision of seamless coordination across professional and organisational boundaries, what is not often considered is how contested interpretations of geography and place shape projects of integrated care. This study presents qualitative data gathered during an evaluation of an integrated care project that took place between 2012-2015 in a metropolitan borough in the North of England. Findings are drawn from 45 qualitative interviews with project managers and front line health and social care staff as well as two years of participant-observations in project and locality team meetings. The findings highlight how the integrated care project involved attempts to create new localities of service provision across the borough shaped around policy and managerial imperatives for more joined-up, integrated and resource-efficient forms of care delivery. New localities were informed by geographical boundaries that contrasted with existing and historical understandings of place, and also struggled for dominance against parallel visions for regional health service reform. It is suggested that that rather than able to construct new cross-boundary social relations based on to a rationalised model of service provision, projects of integration are tightly entwined with the histories and meanings of the places in which they are enacted.
Simon Bishop is Associate Professor in Organisational Behaviour at Nottingham University Business School. HIs research is primarily focused on issues of public policy organisational change in healthcare and other public service organisations. Simon’s PhD focused on organisational change during periods of public service outsourcing and partnership with the private sector. He has conducted several studies on new types of healthcare organisations and services, including Independent Sector Treatment Centres, integrated care providers and knowledge translations organisations. Simon’s research seeks to examine the changing relationships between organisations following changes in public policy - for example those which encourage new forms of partnerships, supply and commissioning arrangements - and how this affects organisational management, work and employment.
3. Analysing the implementation of health care reforms: a decentred approach
Juan I Baeza, King’s College London
Alec Fraser, London School of Hygiene and Tropical Medicine
Annette Boaz, St. George’s, University of London & Kingston University
A bottom-up decentred lens was used to understand how local actors perceive reforms and use their agency to make sense of the change. The aim is to use this perspective to investigate the implementation of the 2007 stroke reforms in England. The stroke reforms can be characterised as a ‘disruptive innovation’ that it challenges existing stakeholders to rethink their current practices through the introduction of new ideas. These potential challenges to the prevailing arrangements, may conflict with the existing beliefs, ideas and traditions of local actors. We add to Bevir’s decentred approach by exploring the roles of context, audit and leadership at the micro level. The paper highlights three key findings. Our micro level data highlight the importance of local context in both shaping and then adapting local actors’ traditions and beliefs and thereby influencing their responses to the resulting dilemmas. These contextual influences are then important in understanding how a macro level policy directive is locally interpreted and implemented. Second, it was surprising to note that the introduction of greater surveillance in the form of audit seemed paradoxically attractive to senior clinicians who were able to use it to govern junior staff and to highlight the need for more resources in stroke care. Our data suggest that dilemmas are individually constructed, put simply, one person’s dilemma can be another’s opportunity. Lastly, in terms of leadership, the decentred approach allowed us to more deeply analyse the jurisdictional power of different professions and question the traditional view of medical supremacy in local leadership. Our data illustrate that stroke specialist nurses can be effective leaders and can be more influential than some senior doctors in implementing change at the local level.
Authors:Dr Juan Baeza is senior lecturer in Health Policy at King's Business School. His research focuses on analysing health policy and health sector reform in the UK and internationally.
4. The contested practice of networking in healthcare management
Paula Hyde, University of Manchester
Networks have been celebrated for some time as vital to the operation of fluid, post-bureaucratic and knowledge-based organisations. However, much of the literature on governing networks prioritises research into formal networks and pays rather less attention to issues of informal and emergent networking. This is often accompanied by a structural-functionalist bias in network research, as networks are ascribed with a self-evident purpose which may be measured and evaluated. The consequence is a neglect of the meaning and practice of networking, as membership, position and participation in networks are taken for granted. We seek to address this gap by exploring, ideographically, the meaning ascribed to informal networking among healthcare managers, and various tensions which result. Using qualitative data from a three-year study of UK healthcare organisations, we explore practices of networking across three defined managerial groups – functional, general and clinical. Our findings highlight the challenges facing attempts to govern such networks.
Paula Hyde is Professor of Organisation Studies at Birmingham Business School, University of Birmingham and holds a visiting position at Macquarie University, New South Wales, Australia. She is a Fellow of the Academy of Social Sciences. Paula is one of the leading figures in the field of organisation studies in
Mark Bevir is Professor at the Department of Political Science and Director of the Center for British Studies at the University of California, Berkeley, USA. He is also a Professor at the Graduate School of Governance, United Nations University - MERIT, Maastricht, the Netherlands. He has published widely on public policy and governance.
Justin Waring is Professor of Medical Sociology and Healthcare Organisation and Deputy Director of the Health Services Management Centre, University of Birmingham. His research deals with the changing organization and governance of public services, with a particular focus on the governance of healthcare professional work.
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