Learning to cross boundaries: The integration of a health network to deliver seamless care

Wijngaarden, Jeroen D H van; Bont, Antoinette de; Huijsman, Robbert

doi:10.1016/j.healthpol.2006.01.002

Cited by 57 publications

(54 citation statements)

References 26 publications

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“…To this extent, networks can be seen as a logical development of the New Public Management policies prevalent across developed-world governments, especially those subject to Anglo-American influences O'Toole 1997). In the UK, health policy was an early adopter of the network principle, with ‗managed clinical networks' introduced in a variety of specialties, including cancer, in the NHS from the mid-1990s, mirroring trends towards networked healthservice delivery in Europe (Wijngaarden et al 2006) and the US (Shortell et al 1994).…”

Section: Cancer Network In the Nhs Modernization And Service Reformmentioning

confidence: 99%

Leadership, Service Reform, and Public-Service Networks: The Case of Cancer-Genetics Pilots in the English NHS

Martin

Currie

Finn

2008

Journal of Public Administration Research and Theory

107

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In attempting to reform public services, governments worldwide have sought to effect change through policies aimed at both transforming structures of public service provision and facilitating the agency of public servants working within these. Various obstacles have been found, however, to impede the effectiveness of such efforts. In this paper, the authors examine the role of organizational networks and distributed leadership-two prominent policies aimed at structure and agency respectively-in the establishment and consolidation of service reform in the English National Health Service. Using a comparative case-study approach, they contrast the trajectories of two attempts to introduce and gain acceptance for service reform, noting important differences of context, process and outcome between the sites. The findings indicate the importance of dispersed, as well as distributed, leadership in achieving change in a networked public-service setting. Effective leaders may indeed achieve change through the structures and processes of the network. However, the coexistence alongside the network of other organizational forms constrains the ability of leaders to achieve change without complementary action beyond the boundaries of the network.

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Section: Cancer Network In the Nhs Modernization And Service Reformmentioning

confidence: 99%

Leadership, Service Reform, and Public-Service Networks: The Case of Cancer-Genetics Pilots in the English NHS

Martin

Currie

Finn

2008

Journal of Public Administration Research and Theory

107

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“…As such, the literature is rich with diagnoses of the barriers to collaborative partnership and how these can be overcome (e.g. Hudson and Hardy, 2002;Stewart et al, 2003;van Wijngaarden, de Bont and Huijsman, 2006). Critical accounts of collaborative partnership practice remain relatively rare, however (e.g.…”

Section: Introductionmentioning

confidence: 99%

The role of boundary maintenance and blurring in a UK collaborative research project: How researchers and health service managers made sense of new ways of working

Smith

Ward

2015

Social Science & Medicine

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The paper investigates whether, how and in what circumstances boundary blurring or boundary maintenance is productive or destructive of sense in collaborative research based on a case study involving researchers from two universities and two principal organisational stakeholders in a local healthcare system in England between 2009 and 2012. Adopting a narrative method, using meeting observation, document analysis and interviews, we describe two key sets of activities in the evolution of collaboration, which allows us to tackle the question at two levels. Studying the production of documents and their use as boundary objects in project management meetings, we show how these were used to enable cooperation by establishing a truce between worldviews, giving participants a better feel for the game and a clearer perception of its stakes. Studying how the partnership expanded to take in other organisations besides the two formal partners, we show how the project accommodated pre-existing organisational interests but thereby sacrificed its experimental ethos. In showing how actors needed to subvert their experimental script to enact collaborative partnership, we argue for understanding and evaluating the latter as the co-produced outcome of disputes and coorientations towards a practical ideal, not as an organisational format for knowledge co-production.

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“…This includes work by Nonaka and his collaborators [41][42][43][44] as well as authors adopting a social practice perspective. 40 Authors concerned with knowledge creation in 'project ecologies', 45,46 with project teams working in parallel, also treat the locus of knowledge creation as a team or group. Most papers report groups as being relatively fluid entities that co-ordinate the knowledge flows between individuals and higher levels of organisations.…”

Section: The Main Themesmentioning

confidence: 99%

The role of informal networks in creating knowledge among health-care managers: a prospective case study

Ward

West

Smith

et al. 2014

Health Services and Delivery Research

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BackgroundHealth and well-being services, in common with many public services, cannot be delivered by a single organisation and require co-ordination across several organisations in a locality. There is some evidence, mostly from other sectors, that middle managers play pivotal roles in this co-ordination by developing networks of relationships with colleagues in other organisations. These networks of relationships, established over time, provide contexts in which managers can, collectively, create the knowledge needed to address the challenges they encounter. Relatively little is known, however, about how these knowledge-creation processes work in a health-care context.AimThis study focuses on how health and well-being managers collectively create knowledge. Our objectives were to develop a better understanding of the way that knowledge is created within and between health-care organisations, across different managerial levels, and of the role played by informal networks in those processes.MethodsThe study was undertaken in health and well-being services in three sites in northern England, employing a case study design. The field methods used were landscape mapping, structured data collection for network analysis and latent position cluster analysis, and semi-structured interviews for narrative analysis. Our network modelling approach used the concepts of latent position network models and latent position cluster models. We used these models to identify clusters of people within networks, and people who acted as bridgers between clusters. We then interviewed middle managers who – on the evidence of our cluster models – occupied similar positions in our graphs. The latter were used to produce practice-based narratives of knowledge creation.ResultsOur narrative results showed that middle managers were synthesisers, in three different senses. First, they draw on different types of information, from a range of sources – quantitative routine data about populations and services, reports on progress against contractual targets, research evidence, and intelligence from colleagues in other localities. Second, they are able to link national policies and local priorities, and reconcile them with local operational realities. They are not always successful, but can integrate the different approaches and working practices of NHS, local authority, private and voluntary organisations. Third, they are able to link ideas, negotiation and action. We found that the network results were most usefully represented asclusters, explaining relationships between actors. Actors within clusters had common attributes, and as a result we were able to interpret the broad purpose of each of the clusters in the graphs for each site. The most useful number of clusters was three or four for both network types, and for both sampling periods, at each of the three sites. The clusters at all three sites had a mix of organisations represented within them. There was a mix of seniorities of managers in all clusters. Relationships were simultaneously formal and informal: formal contracts were managed in a context of ongoing conversations and negotiations. Relationships were simultaneously stable and fluid, with stable ‘cores’ of managers but memberships that varied substantially between two periods of data collection.ConclusionsOur theory about knowledge creation was broadly supported. Managers of health and well-being services develop and maintain knowledge collectively. Their collective efforts are typically manifested either in projects requiring multiorganisational inputs or in taking ideas from genesis to the delivery of a new service. The cluster modelling suggests that networks of managers are able to maintain relationships, and hence conserve technical and prudential knowledge, over months and years. Priorities for future work include establishing the value of latent cluster modelling in understanding the work of groups and teams in other health and social care settings, and studying knowledge creation in the context of the interorganisational co-ordination of services.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Learning to cross boundaries: The integration of a health network to deliver seamless care

Cited by 57 publications

References 26 publications

Leadership, Service Reform, and Public-Service Networks: The Case of Cancer-Genetics Pilots in the English NHS

Leadership, Service Reform, and Public-Service Networks: The Case of Cancer-Genetics Pilots in the English NHS

The role of boundary maintenance and blurring in a UK collaborative research project: How researchers and health service managers made sense of new ways of working

The role of informal networks in creating knowledge among health-care managers: a prospective case study

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