Inter-organizational networks in the health system: Another panacea…or is there something more to them?

Blog post by guest blogger, Ronald Lindstrom, Royal Roads University

An inter-organizational network is a group of organizations working together towards a common purpose to achieve goals that no one organization could accomplish on its own. Many such networks exist in name only without much thought as to how they should be planned, developed, resourced, managed, or governed. Equally important is how such networks could and should co-exist with traditional hierarchical structures (which are necessary in many contexts) since many people and organizations belong to more than one network.

Networks are enigmatic in the sense of being both a structure and a process, fixed and flexible, a noun and a verb, all at the same time. Sometimes people or organizations function as a network, but are not called a network, for example, a community of practice, alliance, and coalition. Given this obfuscation of terminology, and a general tendency to ignore the literature and evidence-base around networks and network science, many are having difficulty understanding what a network really is and does, at least in a social construct. A network should at least address our growing need for multi-stakeholder participation, genuine collaboration, and collective action to respond to the challenges practitioners face day-to-day in the real world of the health system. To effectively do so, requires a network to respond in a number of ways, for example, to the:

• overwhelming complexity of the health system which, for the most part, doesn’t function like a system; rather, it is a patchwork of more or less disconnected entities;
• ‘white space’ between, for example, academe, professions, disciplines, sectors, cultures, ministries, organizations, and communities;
• prevailing silo mentality that, in spite of the continual rhetoric of disapproval, still permeates the health and education system and which, paradoxically, prevents the very participation, collaboration, and collective action to which we aspire;
• different values, worldviews, and perspectives of the multiple stakeholders engaged in the health system;
• different kinds of power that people bring, consciously or unconsciously, to the table, eg, positional, organizational, intellectual, resource, historical, professional, socioeconomic, etc.;
• issues around trust, both real and perceived;
• realities of small and large ‘p’ politics.

In particular, the triad of power, trust, and politics is so pervasive in hierarchical organizations and contributes so greatly, yet so negatively in many cases, to healthy work environments and beyond. This is not new, nor surprising, but what is more important is why this continues in spite of the rhetoric and damaging effects on, for example, the workforce, productivity, and outcomes.

Health services and related organizations still are largely managed in keeping with the traditional management and administrative functions promulgated back in the 1930s (Gulick & Urwick, 1937). See: http://en.wikipedia.org/wiki/POSDCORB. These include: Planning; Organizing; Staffing; Directing; COordinating; Reporting; and, Budgeting. Unfortunately, these tasks have stuck and have become entrenched without a lot of thought about how they might clash with newer organizational forms more in keeping with the needs of, say, the 21^st century! In contrast, new constructs, such as inter-organizational networks, require a much different skill set, more aligned with the capabilities and competencies associated with leadership (as distinguished from management and administration), eg, LEADS in a Caring Environment Framework: Leads self;  Engages others; Achieves results; Develops coalitions; and, Systems transformation. See http://www.leadersforlife.ca/leads-framework. This framework is being embraced right across the country which is testament to the appetite of practitioners to grab hold of the essence of leadership and learn how to apply the principles in their particular work settings.

So, in my view, networks are not another panacea, but there is so much to learn about them if they are to be effective as organizational structures and processes for the health system and related systems. How and where can you learn more about networks? Over the past several years a number of network scholars and practitioners have been meeting to discuss inter-organizational networks in the context of the health and education systems and research. The sixth one is being held at the Royal Roads University campus in Victoria, November 14 & 15 with the theme of learning, leading, and lasting from a life-cycle perspective. For anyone interested in exploring both the theory and practice of inter-organizational networks in the health system and in relation to the very important linkages to the education system and research, this symposium will examine how networks work from a living systems and life-cycle perspective. Over the course of the two days, the four stages of the life-cycle will be explored: birth (how do you know if a network is needed and how do you plan for one?); growth (how do you develop a network?); maturity (how do you maintain a network and evaluate it to determine if it is, in fact, working?); and, death/transformation (should you and how do you phase out or transform a network in response to changing needs and environs?). This symposium will feature keynote speaker, Dr. Fritjof Capra, physicist, leading author, and founding director of the Center for Ecoliteracy at UC Berkeley. Dr. Capra will examine networks from the perspective of living systems, share what works in natural living systems, and set the stage for the two days. He will be present throughout the entire symposium and participate in the closing plenary where the common threads of learning, leading, and lasting (plus leveraging) will be brought together. Breakout sessions will provide a venue for participants to share their own experiences and make the connection with the content of the plenary sessions. A good balance of both practical experience and theoretical knowledge has been planned. Seating is limited so if you interested in participating, please visit the Centre for Health Leadership and Research website. See: http://health-leadership-research.royalroads.ca/event/networks-leadership-symposium-2011

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Ronald R. Lindstrom, PhD, FCCHL
Director, Centre for Health Leadership and Research, and
Henri M. Toupin Research Fellow in Health Systems Leadership
Royal Roads University
Victoria, BC

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