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A network of networks: The governance of deliberative approaches to healthcare improvement and reform

Rick Iedema (Monash Centre for Health Research and Implementation, Monash University, Melbourne, Australia)
Raj Verma (New South Wales Agency for Clinical Innovation, Chatswood, Australia)
Sonia Wutzke (The Sax Institute, Haymarket, Australia)
Nigel Lyons (New South Wales Agency for Clinical Innovation, North Ryde, Australia)
Brian McCaughan (New South Wales Agency for Clinical Innovation, North Ryde, Australia)

Journal of Health Organization and Management

ISSN: 1477-7266

Article publication date: 10 April 2017

893

Abstract

Purpose

To further our insight into the role of networks in health system reform, the purpose of this paper is to investigate how one agency, the NSW Agency for Clinical Innovation (ACI), and the multiple networks and enabling resources that it encompasses, govern, manage and extend the potential of networks for healthcare practice improvement.

Design/methodology/approach

This is a case study investigation which took place over ten months through the first author’s participation in network activities and discussions with the agency’s staff about their main objectives, challenges and achievements, and with selected services around the state of New South Wales to understand the agency’s implementation and large system transformation activities.

Findings

The paper demonstrates that ACI accommodates multiple networks whose oversight structures, self-organisation and systems change approaches combined in dynamic ways, effectively yield a diversity of network governances. Further, ACI bears out a paradox of “centralised decentralisation”, co-locating agents of innovation with networks of implementation and evaluation expertise. This arrangement strengthens and legitimates the role of the strategic hybrid – the healthcare professional in pursuit of change and improvement, and enhances their influence and impact on the wider system.

Research limitations/implications

While focussing the case study on one agency only, this study is unique as it highlights inter-network connections. Contributing to the literature on network governance, this paper identifies ACI as a “network of networks” through which resources, expectations and stakeholder dynamics are dynamically and flexibly mediated and enhanced.

Practical implications

The co-location of and dynamic interaction among clinical networks may create synergies among networks, nurture “strategic hybrids”, and enhance the impact of network activities on health system reform.

Social implications

Network governance requires more from network members than participation in a single network, as it involves health service professionals and consumers in a multi-network dynamic. This dynamic requires deliberations and collaborations to be flexible, and it increasingly positions members as “strategic hybrids” – people who have moved on from singular taken-as-given stances and identities, towards hybrid positionings and flexible perspectives.

Originality/value

This paper is novel in that it identifies a critical feature of health service reform and large system transformation: network governance is empowered through the dynamic co-location of and collaboration among healthcare networks, particularly when complemented with “enabler” teams of people specialising in programme implementation and evaluation.

Keywords

Citation

Iedema, R., Verma, R., Wutzke, S., Lyons, N. and McCaughan, B. (2017), "A network of networks: The governance of deliberative approaches to healthcare improvement and reform", Journal of Health Organization and Management, Vol. 31 No. 2, pp. 223-236. https://doi.org/10.1108/JHOM-07-2016-0146

Publisher

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Emerald Publishing Limited

Copyright © 2017, Emerald Publishing Limited

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