Introduction
The ingrained complexity of modern health systems necessitates an intricate web of effective collaborations and networks. These health networks, serving as conduits for service delivery and as platforms for healthcare innovation, have the onerous task of ameliorating health outcomes. However, despite the pervasiveness of networks within the healthcare landscape, there has been a dearth of rigorous frameworks enabling comprehensive evaluation of their functionality and endurance. This gap crucially demands attention given the significant investment placed by governments and stakeholders in health networks, anticipating a marked improvement in service quality and overall health metrics. The culmination of a project spearheaded by interdisciplinary experts from the Menzies School of Health Research and Australian Institute of Health Innovation—one notably including Frances Clare Cunningham, Geetha Ranmuthugala, Johanna Irene Westbrook, and Jeffrey Braithwaite—proposes to fill this void with the design of an incisive evaluation framework for assessing health networks.
Comprehensively detailed in ‘BMJ Open’, this framework has been meticulously crafted to furnish stakeholders with an instrument to appraise the multifaceted aspects of clinical and health networks. Let us embark on a comprehensive examination of this framework, its conceptual underpinnings, and the dialogues it promotes within the health systems community.
DOI: 10.1136/bmjopen-2018-024231
Methodology
The research leaned on the consolidation of systematic literature reviews, theoretical exposition, and empirical studies examining the evaluation of both health and non-health networks. To encapsulate the full spectrum of network intricacies, brainstorming, and mind-mapping techniques were marshaled within expert advisory group sessions, allowing the thorough dissection of existing network frameworks. The iterative process also integrated stakeholder feedback from networks to fine-tune this instrument.
Framework Outline
The proposed framework unfurls across several dimensions:
1. Network Goals and Characteristics: Initial considerations involve aligning the network’s objectives with its inherent characteristics, crafting a foundational understanding for subsequent evaluations.
2. Relationships Mapping: Recognizing that networks thrive on interaction, the framework analyzes the dynamics at the member, network, and community levels.
3. Network Outcomes: This encompasses a qualitative and quantitative appraisal of network-driven outcomes, considering the mediating effect of intervening variables.
4. Longitudinal Assessment: Success and sustainability are inspected over a continuum—short term to long term—to account for temporal shifts and progressive impacts.
The merits of the framework lie in its scalability and adaptability, as it factors in various network forms and developmental stages. It serves as a tool that is sufficiently comprehensive to encapsulate myriad theoretical insights and sufficiently flexible to assess a wide array of health networks.
Discussion
The design of this framework heavily borrows from seminal works such as those by Sheaff et al. who explored network resilience during health system reforms, and Turrini et al. who delved into the determinants of network effectiveness. Moreover, it recognizes the dynamic nature of health networks as elucidated by Provan and Milward in their discourse on managing the hollow state through networks. This approach acknowledges the requisite evolution of evaluation tools, necessitating a tool capable of traversing the complexities in network configurations and outcomes.
The framework also pays homage to pioneering contributions on the dilemmatic nature of planning within wicked problems, as explored by Rittel and Webber and the intricate dissection of the post-bureaucratic organization by Heckscher and Donnellon. It lends an ear to the enduring discourse on organizational networks and capital—ushering insights from grandees like Coleman’s social capital theory and Lawless and Moore’s expositions on interorganizational systems in public service.
The complexity of health networks commands a comprehensive tool for their evaluation, as evidenced by long-standing challenges in the integration of human services highlighted by Agranoff and McGuire. Additionally, network theories from Borgatti et al., which unravel the nuances of social network analysis, provide a calculous touchstone for the intellectual fabric of the framework.
The BMJ Open article also pays due respect to the inextricable links between networks and organizational learning, with a persuasive nod to Addicott, McGivern, and Ferlie’s studies on NHS cancer networks and Balkundi and Harrison’s exploration of team structure effects on performance and viability.
Furthermore, the need for this framework is underpinned by the recognition that health professional networks are indeed vectors for enhancing healthcare quality and safety, a narrative ardently championed by authors Cunningham et al. Through its design, the framework looks to anchor itself as a linchpin in network research, policy formation, and healthcare quality enhancement.
Limitations and Future Research
Whilst the framework offers an extensive foray into the evaluation ecosystem, limitations are acknowledged. The framework’s robustness is subject to empirical testing across diverse health networks to establish its universal applicability. Moreover, the authors call for the evaluation framework to be a living tool, undergoing revisions and improvements in alignment with emerging insights from future studies.
Conclusion
The project team, with contributions from such esteemed researchers as Cunningham, Ranmuthugala, Westbrook, and Braithwaite, presents a forward-thinking framework that holds implications for the future methodological purity of network evaluations. Through this framework, there is the potential to facilitate improvements in healthcare delivery, inter-organizational synergy, and ultimately, patient-centric outcomes. The blazoned call for the continued empirical interrogation underscores the aspirational nature of this development—to refine the mirror in which we observe the complexities of our health networks.
References
1. Sheaff R, Benson L, Farbus L, et al. Network resilience in the face of health system reform. Soc Sci Med 2010;70:779–86.
2. Turrini A, Cristofoli D, Frosini F, et al. Networking literature about determinants of network effectiveness. Public Adm 2010;88:528–50.
3. Provan KG, Milward HB. Managing the hollow state: collaboration and contracting. Public Manag Rev 2003;5:1–18.
4. Heckscher C, Donnellon A. The post-bureaucratic organisation: new perspectives on organisational change. Thousand Oaks, California: Sage Publications, 1994.
5. Rittel HWJ, Webber MM. Dilemmas in a general theory of planning. Policy Sci 1973;4:155–69.
Keywords
1. Health Networks Evaluation
2. Clinical Network Effectiveness
3. Framework for Health Outcomes
4. Healthcare System Collaboration
5. Sustainable Health Network Analysis