Decentring Health and Care Networks: Reshaping the Organization and Delivery of Healthcare (Organizational Behaviour in Healthcare)

Networks have become a prominent template for public service governance. Often seen as an alternative to hierarchies and contracts, networks cross institutionalized organizational or sectoral boundaries to promote collaboration and the sharing of resources when addressing complex problems. Nowhere is this more the case than in the field of health services modernization and improvement. Comprising unique empirical contributions, drawn primarily from the experience of the UK National Health Service (NHS), this edited collection develops a 'decentred' analysis of health and care networks. Contributors look beyond particular structures or patterns of governance and focus instead on the interpretation of the meaningful practices of policy actors as they encounter and enact policy instruments and structures. The approach offers a distinct form of analysis that deepens and enriches more traditional public policy accounts of network governance. It recognizes the influence of local history, highlights the influence of dominant economic, technical and corporate narratives, and acknowledges the continued influence of biomedical knowledge and professional expertise. Offering practical insight for current and future service leaders about the challenges of implementing, managing and working within networks, this book draws out key messages for practitioners and researchers alike. Mark Bevir is Professor at the Department of Political Science and Director of the Center for British Studies at the University of California, Berkeley, USA. He is also a Professor at the Graduate School of Governance, United Nations University - MERIT, Maastricht, the Netherlands. He has published widely on public policy and governance. Justin Waring is Professor of Medical Sociology and Healthcare Organisation and Deputy Director of the Health Services Management Centre, University of Birmingham. His research deals with the changing organization and governance of public services, with a particular focus on the governance of healthcare professional work. Contents 6 Notes on Contributors 8 List of Figures 18 List of Tables 19 Decentring Networks and Networking in Health and Care Services 20 The Network Narrative 20 Networks and Networking in Healthcare 24 Decentred Theory 27 The Contributions to This Collection 31 References 33 The Contested Practice of Networking in Healthcare Management 36 Introduction 36 Networks in Healthcare Organisations 38 Methodological Approach 42 Diversity of Networks Across Organisations and Groups 43 Who Networks, and Why? 46 Networking for Knowledge 46 Networking for Support 47 Networking for Career 49 Networking for Influence 51 Multiplexity of Networking 52 Challenges to Networking 53 Networking in Context 54 Conclusions 56 References 58 Analysing the Micro Implementation of Health Care Reforms: A Decentred Approach 62 Introduction 62 Developing Stroke as a Specialty 64 Our Study 66 Case Study 1 (CS1) 67 Case Study 2 (CS2) 67 Findings 68 The Importance of Context in Shaping Beliefs and Traditions 68 The Role of Audit in Shaping Attitudes and Behaviour 70 The Importance of Leadership in Implementation 74 Discussion 79 References 82 Buddies and Mergers: Decentring the Performance of Healthcare Provider Partnerships 85 Introduction 85 Partnering for Improvement 87 Case Studies of NHS Provider Partnerships 92 Dilemmas in Leadership and Management 95 Dilemmas in Performance Measurement 99 Dilemmas in Stakeholder Relationships 101 Discussion 103 Conclusion 107 References 108 Space and Place in Network Governance: Putting Integrated Care into Place 113 Introduction—Networks and Integrated Care 113 Decentring Integrated Health and Social Care 115 Place and Space of Integrated Care 117 Case Study Background 120 Getting Integrated Care off the Ground 121 Re-mapping Localities 123 Creating Shared Space 126 Reshaping Hierarchy 128 Discussion and Conclusion 131 References 135 Situating Practices of Human and Non-human Networks in the Delivery of Emergency and Urgent Care Services 139 Introduction 139 Triaging Emergency and Urgent Care Using CDSS 142 The Empirical Studies 144 Governing Rules and Networked Realities 145 Rule 1: Clarity of Comprehension 145 Rule 2: Assume Singularity 148 Rule 3: Linearity 149 Rule 4: Expertise in the Machine Not the Mind 150 Rule 5: No Gaming 152 Discussion 153 References 156 Sharing Stories or Co-Constructing Practice? Challenges to Undertaking and Researching Innovation Using Evidence from the English NHS 159 Introduction 159 Stories, Dilemmas, and Traditions 161 Interaction as Shared or Dialogical Practice 162 Methods 164 Findings 167 Vignette 1: Deciding Whether to Roll Out Local Quality Improvement Work More Widely 167 Vignette 2: Updating Front-Line Staff on the Quality Improvement Work 168 Interpretation: What’s the Dilemma? 169 Interpretation: What’s the Tradition? 170 What’s the Story? 172 Individual Story or Joint Action? 174 Discussion 174 Conclusion 177 References 178 Networking for Health, Networking for Wealth: A Study of English Health Innovation Policy in Practice 180 Introduction and Background 180 The UK Health Policy Context: Financial Austerity and Poor Population Health 183 Harnessing the Potential of Health Innovation as a Policy Solution 184 Antecedents to the Formation of AHSNs 187 ‘Networking Anchoring’: Tracking the Early Progress of AHSNs 189 From Network Anchoring to Network Consolidation 193 Discussion 195 Conclusions 198 Afterword 200 References 200 Tensions Between Technocracy, Scientific Knowledge and Co-production in Collaborative Health and Care Networks 204 Introduction 204 Technocratic, Scientific and Co-produced Evidence 206 Converging Traditions in Applied Health Research 209 Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) 212 The Example of One CLAHRC 216 The Prerequisite for Scientific Knowledge and Technocracy 216 Technocratic Operations 218 The Desire for Co-production 220 Resolving the Tensions 221 Conclusions 223 References 226 Is Co-production Just Really Good PPI? Making Sense of Patient and Public Involvement and Co-production Networks 230 Introduction 230 Bringing the Outsiders in: A Brief History of PPI in England 232 The Structural Underpinnings of Inequitable PPI Practice 239 Co-production: Gold Standard or Mis-Sold PPI? 242 Conclusion 249 References 250 Professional Pastoral Work in a Kenyan Clinical Network: Transposing Transnational Evidence-Based Governmentality 255 Introduction 255 Evidence-Based Governmentality and ‘Pastoral’ Professionals in Health Care 257 Criticisms of the Governmentality Literature 261 Methods 263 Empirical Findings 264 Development of a Transnational Evidence-Based Governmentality in Kenyan Paediatric Care 264 Formation of the Clinical Information Network 268 Implementation of an Evidence-Based Governmentality Within the Clinical Information Network 269 Disciplining and Normalisation of Evidence-Based Governmentality in Kenyan Paediatric Care 272 Discussion 273 References 277 Index 283 Front Matter ....Pages i-xix Decentring Networks and Networking in Health and Care Services (Mark Bevir, Justin Waring)....Pages 1-16 The Contested Practice of Networking in Healthcare Management (Paula Hyde, Damian Hodgson, Simon Bailey, John Hassard, Mike Bresnen)....Pages 17-42 Analysing the Micro Implementation of Health Care Reforms: A Decentred Approach (Juan I. Baeza, Alec Fraser, Annette Boaz)....Pages 43-65 Buddies and Mergers: Decentring the Performance of Healthcare Provider Partnerships (Ross Millar, Russell Mannion, Robin Miller)....Pages 67-94 Space and Place in Network Governance: Putting Integrated Care into Place (Simon Bishop)....Pages 95-120 Situating Practices of Human and Non-human Networks in the Delivery of Emergency and Urgent Care Services (Catherine Pope)....Pages 121-140 Sharing Stories or Co-Constructing Practice? Challenges to Undertaking and Researching Innovation Using Evidence from the English NHS (Simon Turner, John S. F. Wright)....Pages 141-161 Networking for Health, Networking for Wealth: A Study of English Health Innovation Policy in Practice (Jean Ledger)....Pages 163-186 Tensions Between Technocracy, Scientific Knowledge and Co-production in Collaborative Health and Care Networks (Robert Vickers, Bridget Roe, Charlotte Overton)....Pages 187-212 Is Co-production Just Really Good PPI? Making Sense of Patient and Public Involvement and Co-production Networks (Oli Williams, Glenn Robert, Graham P. Martin, Esmée Hanna, Jane O’Hara)....Pages 213-237 Professional Pastoral Work in a Kenyan Clinical Network: Transposing Transnational Evidence-Based Governmentality (Gerry McGivern, Jacinta Nzinga, Mehdi Boussebaa, Mike English)....Pages 239-266 Back Matter ....Pages 267-272