Background Collaborative networks of health organizations have received a great deal of attention in recent years as a way of enhancing the flow of information and coordination of services. However, relatively little is known about how such networks are formed and evolve, especially outside a local, community-based setting. This article is an in-depth discussion of the evolution of the North American Quitline Consortium (NAQC). The NAQC is a network of U.S. and Canadian organizations that provide telephone-based counseling and related services to people trying to quit smoking. Methodology The research draws on data from interviews, documents, and a survey of NAQC members to assess how the network emerged, became formalized, and effectively governed. Findings The findings provide an understanding of how multiregional public health networks evolve, while building on and extending the broader literature on organizational networks in other sectors and settings. Specifically, we found that the network form that ultimately emerged was a product of the back-and-forth interplay between the internal needs and goals of those organizations that would ultimately become network members, in this case, state-, and provincial-level tobacco quitline organizations. We also found that network formation, and then governance through a network administrative organization, was driven by important events and shifts in the external environment, including the impact and influence of major national organizations. Practice Implications The results of the study provide health care leaders and policy officials an understanding of how the activities of a large number of organizations having a common health goal, but spanning multiple states and countries, might be coordinated and integrated through the establishment of a formal network.

This research examines the awareness of evidence based practices by the public organizations that fund services in the North American Quitline Consortium (NAQC). NAQC is a large, publicly funded, goal-directed “whole network,” spanning both Canada and the U.S., working to get people to quit smoking. Building on prior research on the dissemination and diffusion of innovation and evidence based practices, and considering differences between network ties that are homophilous versus instrumental, we found that awareness of evidence based practices was highest for quitline funders that were strongly connected directly to researchers and indirectly to the network administrative organization, controlling for quitline spending per capita and decision making locus of control. The findings support the importance of maintaining instrumental (a technical-rational argument) rather than homophilous ties for acquisition of evidence based practice knowledge. The findings also offer ideas for how public networks might be designed and governed to enhance the likelihood that the organizations in the network are better aware of what evidence based practices exist.

We examine how and why public-nonprofit networks incorporate vertical complexity into their governance structures to allow network members to participate in the decision-making process. Our results show that public-nonprofit networks establish levels of vertical complexity by hiring network coordinators and establishing group modes of governance (steering committees and workgroups). The representatives of the leading agencies state that vertical complexity is necessary in terms of balancing inclusiveness and efficiency in the network. The network members confirm that next to coordinators acting as stewards and mediators, group modes of governance are equally important for counterbalancing the uneven distribution of decision-making power and for restoring trust.

Governance within the growing number of multiorganizational international nongovernmental organization (INGO) families in the humanitarian sector is challenging. Ideas are evolving about what the objectives of humanitarian INGOs should be, what the most appropriate means of achieving these objectives are, and how best to demonstrate effectiveness and integrity to others. Within this context, scholars observe that choices in governance approaches are driven largely by internal politics within the bounds of legitimacy, leading some to refer to INGOs as principled‐instrumentalists. However, we know little about the principles bounding these instrumental choices. Drawing from an institutional logics perspective, this paper compares the multiorganizational governance arrangements of 40 humanitarian INGO families with the values they espouse in their statements of values, principles, or beliefs. The idea being that these statements of values can serve as a window into the logics guiding organizational decision‐making and provide the basis for how power is enacted and strategies chosen within these social settings. These findings have the potential to help leaders of multisite nonprofits make sense of the ways changing values, beliefs, and logics are prompting their organizations to reconsider how they balance inherent management tensions.