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1 – 10 of over 72000Larry R. Hearld and Daan Westra
Networked forms of organizing in health care are increasingly viewed as an effective means of addressing “wicked”, multifaceted health and societal challenges. This is because…
Abstract
Networked forms of organizing in health care are increasingly viewed as an effective means of addressing “wicked”, multifaceted health and societal challenges. This is because networks attempt to address these challenges via collaborative approaches in which diverse stakeholders together define the problem(s) and implement solutions. Consequently, there has been a sharp increase in the number and types of networks used in health care. Despite this growth, our understanding of how these networks are governed has not kept pace. The purpose of this chapter is to chart a research agenda for scholars who are interested in studying health care network governance (i.e., the systems of rules and decision-making within networks), which is of particular importance in deliberate networks between organizations. We do so based on our knowledge of the literature and interviews with subject matter experts, both of which are used to identify core network governance concepts that represent gaps in our current knowledge. Our analysis identified various conceptualizations of networks and of their governance, as well as four primary knowledge gaps: “bread and butter” studies of network governance in health care, the role of single organizations in managing health care networks, governance through the life-cycle stages of health care networks, and governing across the multiple levels of health care networks. We first seek to provide some conceptual clarity around networks and network governance. Subsequently, we describe some of the challenges that researchers may confront while addressing the associated knowledge gaps and potential ways to overcome these challenges.
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Managed care networks enable virtual integration of health, social care and housing service delivery. When focused on outcomes and experience for service users and carers, they…
Abstract
Managed care networks enable virtual integration of health, social care and housing service delivery. When focused on outcomes and experience for service users and carers, they can provide integrated support for improvement in the pathways, processes and experience of care and support for older people. This paper provides a case study of the development of a managed care network of health and social care partners in Lanarkshire in the context of current policy drivers in Scotland.
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Arno van Raak, Aggie Paulus, Frits van Merode and Ingrid Mur‐Veeman
Delivery of integrated care by interorganisational networks attracts much attention in Europe. Such care is required to meet the demands of multi‐problem patients. Many efforts…
Abstract
Delivery of integrated care by interorganisational networks attracts much attention in Europe. Such care is required to meet the demands of multi‐problem patients. Many efforts are made to establish networks. Often, established networks do not deliver integrated care. Managers must understand the background of this problem, in order to deal with it. The issue addressed here concerns behaviour control in networks of autonomous care‐providing organisations. So far, publications have focused on behaviour control in single organisations. Based on empirical data we argue that, due to an essential distinction between networks and single organisations, behaviour control in the former should be approached differently. In addition, we discuss the implications of our findings for the management of integrated care delivery.
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Sharon J. Williams, Zoe Radnor, James Aitken, Ann Esain and Olga Matthias
This research examines how knowledge and information are managed within two care networks. We develop a conceptual framework drawing on the notion of brokering and the 3T…
Abstract
Purpose
This research examines how knowledge and information are managed within two care networks. We develop a conceptual framework drawing on the notion of brokering and the 3T framework, which is used to describe the relative complexity of boundaries (referred to in the framework as syntactic, semantic and pragmatic) as well as capabilities and processes required to exchange information within the network. Previous research on brokering has focused on healthcare managers and professionals, but this research extends to patients and caregivers. Understanding knowledge exchange and brokering practices in healthcare is critical to the delivery of effective services.
Design/methodology/approach
For this case research, non-participant observation and experienced-based interviews were undertaken with healthcare professionals, patients and caregivers within two care networks.
Findings
The findings reveal brokering roles occupied by healthcare professionals, patients and caregivers support the transfer, translation and transformation of knowledge and information across functional and organisational boundaries. Enablers and disablers to brokering and the exchange of knowledge and information are also identified.
Research limitations/implications
The study is limited to two care networks for long-term conditions within the UK. Further research opportunities exist to examine similar care networks that extend across professional and organisational boundaries.
Practical implications
This research informs healthcare professionals of the brokering capabilities that occur within networks and the enabling and disabling factors to managing knowledge across boundaries.
Originality/value
This paper provides a conceptual framework that categorises how increased levels of knowledge and information exchange and brokering practices are managed within care networks.
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The challenges facing today's Mexican migrant population, almost a third of the US migrant population, are formidable. Such high representation offers not only challenges, but…
Abstract
The challenges facing today's Mexican migrant population, almost a third of the US migrant population, are formidable. Such high representation offers not only challenges, but also increased political representation and large networks of social support. Complex relationships established through such networks provide Mexican migrants with avenues of access to communities, opportunities and services. Following a working definition of community and the concept of social capital, this paper examines health care availability for Mexican migrants in the United States. Because Mexican women are traditionally responsible for the health of their families, a case study is used to illustrate how knowledge and information gained through women's social networks gives Mexican women in the US critical decision‐making power with regard to health care. Greater acknowledgement of women as the brokers of health‐preserving information networks is key to recognising their significance as stakeholders in community health care. Future policy developers should recognise the importance of understanding such specific contextual issues, because they create a health care system that is responsive to individual and community needs.
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Lusine Poghosyan, Robert J. Lucero, Ashley R. Knutson, Mark W. Friedberg and Hermine Poghosyan
The purpose of this paper is to synthesize existing evidence regarding health care team networks, including their formation and association with outcomes in various health care…
Abstract
Purpose
The purpose of this paper is to synthesize existing evidence regarding health care team networks, including their formation and association with outcomes in various health care settings.
Design/methodology/approach
Network theory informed this review. A literature search was conducted in major databases for studies that used social network analysis methods to study health care teams in the USA between 2000 and 2014. Retrieved studies were reviewed against inclusion and exclusion criteria.
Findings
Overall, 25 studies were included in this review. Results demonstrated that health care team members form professional (e.g. consultation) and personal (e.g. friendship) networks. Network formation can be influenced by team member characteristics (i.e. demographics and professional affiliations) as well as by contextual factors (i.e. providers sharing patient populations and physical proximity to colleagues). These networks can affect team member practice such as adoption of a new medication. Network structures can also impact patient and organizational outcomes, including occurrence of adverse events and deficiencies in health care delivery.
Practical implications
Administrators and policy makers can use knowledge of health care networks to leverage relational structures in teams and tailor interventions that facilitate information exchange, promote collaboration, increase diffusion of evidence-based practices, and potentially improve individual and team performance as well as patient care and outcomes.
Originality/value
Most health services research studies have investigated health care team composition and functioning using traditional social science methodologies, which fail to capture relational structures within teams. Thus, this review is original in terms of focusing on dynamic relationships among team members.
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The purpose of this paper is to develop a theory of governing in integrated care networks. Asking how and why the governance of these networks emerges and evolves over time, it…
Abstract
Purpose
The purpose of this paper is to develop a theory of governing in integrated care networks. Asking how and why the governance of these networks emerges and evolves over time, it responds to calls for more innovative thinking in this field.
Design/methodology/approach
Data result from a rare longitudinal qualitative case study conducted with the Healthcare Centre Lower Engadin, the lead organisation of pioneering health and social care network in a rural Swiss region.
Findings
Actors governed the network through repetitive sequences of collaborative inquiry, a practice through which they defined and addressed recurrent problems of network governance and joint network action in creative and experimental ways.
Research limitations/implications
Explaining how and why the governance of integrated care networks emerges and evolves, this study adds a dynamic theory to previous research, which has studied the determinants of effective network governance without considering their temporal evolution. It also contributes to the wider network literature, drawing attention to the pivotal role of meaning making, creativity and experimentation for understanding network governance dynamics.
Practical implications
The study invites practitioners to reflect on how they want to design collaborative inquiry in their own contexts. Important design levers include the creation of communication forums, trust and information transparency.
Originality/value
The study adds a rare longitudinal perspective on the governance of integrated care networks.
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Shannon L. Sibbald and Robert Sibbald
The South West Health Ethics Network (SWHEN) was created to bring together health care providers from a variety of health care settings across a geographical region. SWHEN’s…
Abstract
Purpose
The South West Health Ethics Network (SWHEN) was created to bring together health care providers from a variety of health care settings across a geographical region. SWHEN’s mission was to connect health professionals who have an interest in ethical issues. SWHEN’s target participants are people with an interest in this field regardless of the individual’s capacity within an ethics profession. While other ethics networks exist, few of these expand beyond a narrow scope of ethics professionals (clinical ethicists). The preliminary vision in bringing together this group was to create a regional collaborative to educate, share lessons and begin to create a common approach to ethics issues in our region. Ethics networks increase collaboration and the exchange of resources, information and ideas among clinical ethicists. As a result, they address many of the ethical dilemmas faced in integrated care and facilitate the success of these systems in providing coordinated patient care. The paper aims to discuss these issues.
Design/methodology/approach
A Delphi consensus building approach was conducted to determine goals and priorities of the network.
Findings
Several priorities and counter priorities were discussed. In the end, the network was stifled by three major challenges: resource sharing, balance of network priorities and individual needs, and leadership.
Originality/value
While the journey to creating a sustainable network is long and complex, it is still worth the struggles. Network members remained connected through e-platforms, and the meetings have increased our region’s cohesiveness around ethics. We remain cautiously optimistic of SWHENs future and acknowledge that our initial plan may have shifted but our achievements are still meaningful and worthwhile.
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Bill Doolin and Andrew W. Hamer
This chapter examines why managed clinical networks are an appropriate approach to sustainable healthcare, and discusses the conditions for the effectiveness of these…
Abstract
Purpose
This chapter examines why managed clinical networks are an appropriate approach to sustainable healthcare, and discusses the conditions for the effectiveness of these multi-stakeholder, clinician-led modes of organizing. It describes the development of a national clinical network to achieve system-wide improvement in the provision of publicly funded cardiac surgery services in New Zealand, and the subsequent evolution of a broader network encompassing the whole cardiac care patient pathway.
Design
The case study of the two cardiac clinical networks focuses on the emergence and evolution of the networks over a four-year period from 2009. Data were collected from interviews with key stakeholders of both networks and from internal and published documentary evidence. Analysis of the case study is informed by network theory and prior studies of managed clinical networks.
Findings
Progress made towards the achievement of the goals of the initial cardiac surgery network encouraged a broadening of focus to the entire cardiac care pathway and the establishment of the national cardiac network. An important benefit has been the learning and increase in understanding among the different stakeholders involved. Both clinical networks have demonstrated the value of clinician engagement and leadership in improving the delivery of health services, and serve as a best practice model for the development of further clinical networks for health services that require a national population base.
Originality and value
The case study analysis of the two cardiac clinical networks identifies five mutually reinforcing themes that underpin network effectiveness: network structure, management and governance, and internal and external legitimation. These themes encompass a number of factors suggestive of successful managed clinical networks, and offer insights into the use of such networks in organizing for sustainable healthcare.
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