A catalyst for system change: a case study of child health network formation, evolution and sustainability in Canada

Abstract

BackgroundThe purpose of this study was to examine key processes and supportive and inhibiting factors involved in the development, evolution, and sustainability of a child health network in rural Canada. This study contributes to a relatively new research agenda aimed at understanding inter-organizational and cross-sectoral health networks. These networks encourage collaboration focusing on complex issues impacting health – issues that individual agencies cannot effectively address alone. This paper presents an overview of the study findings.MethodsAn explanatory qualitative case study approach examined the Network's 13-year lifespan. Data sources were documents and Network members, including regional and 71 provincial senior managers from 11 child and youth service sectors. Data were collected through 34 individual interviews and a review of 127 documents. Interview data were analyzed using framework analysis methods; Prior's approach guided document analysis.ResultsThree themes related to network development, evolution and sustainability were identified: (a) Network relationships as system triggers, (b) Network-mediated system responsiveness, and (c) Network practice as political.ConclusionsStudy findings have important implications for network organizational development, collaborative practice, interprofessional education, public policy, and public system responsiveness research. Findings suggest it is important to explicitly focus on relationships and multi-level socio-political contexts, such as supportive policy environments, in understanding health networks. The dynamic interplay among the Network members; central supportive and inhibiting factors; and micro-, meso-, and macro-organizational contexts was identified.

Barriers to the Integration of Care in Inter-Organisational Settings: A Literature Review

“…Power imbalances and conflicts: Perceived or real power asymmetries can become a strong barrier to inter-organisational collaboration and affect collaboration outcomes [2358]. For instance, the dependence of one organisation on another can work as a barrier if the more powerful organisation does not provide the necessary input [59].…”

“…In case of power imbalances organisations often start to defend their own resources and authority, which often leads to power conflicts [5760]. Power imbalances can also slow down planning and committee work in health service networks [58]. …”

“…no effect on the collaboration, its transformation or even its termination. For instance, barriers in the formation phase of a collaboration can prevent collaboration before it even begins, one example being a lack of organisational resources and financial uncertainties [1858]. Almost all of the works included in this literature review – as far as they are documented – deal with barriers during the implementation or later stages of a collaboration, and none of them gives reasons for the failure of a collaboration.…”

Organizing Health Care Networks: Balancing Markets, Government and Civil Society

“…the NHS Clinical Networks). Various case studies indeed suggest that governmental policy can operate as an important catalyst for HCN formation [2829]. Another relevant example of such policy is Belgium, where the government is developing policy that would legally require all Belgian hospitals to become part of a single larger hospital network.…”

“…One example is that of a Canadian child health network which worked, successfully, in close collaboration with the provincial department of Health Staff. However, it was also reported that ‘at times the provincial staff tried to control the Network strategic agenda and micromanaged key shared projects’ [29]. A respondent reported that this ‘really caused a lot of problems’ [29].…”