Governance, structure and effectiveness of multilevel networks: the case of regional healthcare networks in the Netherlands

Galina van der Weert, Katarzyna Burzynska, Joris Knoben


In the case of an emergency, it is vital that acute care providers collaborate to provide care to the patient in a short time frame. Typically many actors at multiple levels are involved, including hospitals, general practitioners, ambulance services and health insurers. There is no time to figure out each organization’s responsibility by the time the emergency has happened, while it is paramount the patient arrives at the most suitable care provider as fast as possible. To streamline this process, an appropriate network structure and governance is critical. Organizational theory distinguishes three modes of governance; the self-governed network, a network with a lead organization and a network administrative organization. The effectiveness of governance mode is assumed to be affected by the network characteristics trust, size (number of actors), consensus about goals, and the need for network-level competencies. For example, a network governed by a network administrative organization should be characterized by moderate density, with the NAO as the most central organization that has the best network competencies, and a basic level of trust in the NAO. Unfortunately, little empirical evidence supports these claims. Moreover, how the multilevel nature of healthcare networks affects the relations between network characteristics, governance and effectiveness is until now under-theorized. This study will investigate the network characteristics, governance and effectiveness of multiple levels of acute care networks in the Netherlands. Organizations providing acute care in the Netherlands collaborate in eleven regional- and one national network, to make agreements about healthcare provision in the case of emergency, governed by a Network Administrative Organization. Within these networks, organizations are represented by their board members, managers, policy workers and professionals, resulting in over 100 members per region. Hence, acute care in the Netherlands is organized in multilevel networks. Collaborating on this scale requires a form of governance, fitting with the goal and structure of the network, that can align all the partners and activities. With this study we assess how multilevel structures and governance relate to each other and to network effectiveness. To do so, three types of data are gathered within the eleven regional networks of acute care in the Netherlands: desk research (document analysis), census data on social networks and interviews with important stakeholders. Documents give insight in how every region has arranged its policy- and decision making. A survey with census data targets the collaboration network as well as the information sharing network. We apply social network analysis to visualize the individual, organizational and network level and study the alignment among the different levels according to the dual linked design proposed by Lazega et al. (2008). With this information we map the individual and organizational networks and link this to the formal type of governance portrayed in documents and interviews. Finally we test whether networks where the internal structure fits with the applied form of governance, are more effective. This has significant implications for network theory and practice.

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