Academic journal article Australian Health Review

Networks: A Key to the Future of Health Services

Academic journal article Australian Health Review

Networks: A Key to the Future of Health Services

Article excerpt


Health service reforms and structures have, in general, emphasised hierarchical systems to enable control and accountability. In doing so, policies have substantially sidelined networks and their potential for contributing to health service performance. Networks play a number of roles, such as in supporting expertise development, arranging referrals, coordinating programs, undertaking projects, sharing common interests and providing mutual support in managing common conditions. They handle knowledge, support expertise and deal with complexity in ways that hierarchies are unable to, and are fundamental to supporting professionalism. Until networks are used to a greater extent, the development of health services will be substantially impeded. This will require enhancing the role and contribution that networks play, which is dependent on resources, leadership and skills.

Aust Health Rev 2005: 29(3): 317-326

HEALTH SYSTEMS AROUND THE WORLD have been searching for better ways to improve their performance. In general, they have moved away from the traditional dominance of clinical professions to a greater reliance on managerial control and accountability, either through a politically structured hierarchy, or through market forces of some type. This may be supplemented by increasing engagement with patient and/or community interests. In New Zealand, Australia and the United Kingdom, political accountability has tended to dominate, with a hierarchical structure consisting of a regional body (District, Area or Trust) which is responsible to a central body for managing health services in that region.

Despite this clear assignment of accountability and the presence of supporting control structures, there remains extensive dissatisfaction with the way that services are managed and provided,1,2 resulting in continual modification of services and, at times, substantial restructuring. A major reason for this situation is that little recognition has been given to the limitations of hierarchies and central bodies when dealing with diverse, complex services with uncertain outcomes.3 There is also neglect of networks in distilling and integrating the knowledge and understanding required for the provision of services, for strategic decision-making and for the development of the industry. The demands on the hierarchical structure are beyond its capabilities and the support networks that enable clinicians and patients to contribute to addressing problems are inadequate.

The meaning of "networks"

Networks are complexes of links between individuals and organisations, driven largely by the interests of the parties and their recognition of the value of working together. Although networks have always pervaded society, especially where knowledge has been important, only recently have they been recognised as a key element of organisation. Recent books have highlighted their increasing role as commercial alliances4 and public sector collaborations.5 Tenbensel details network hierarchy and market mechanisms: "Whereas price and authority are the mechanisms applicable to markets and hierarchies respectively, the equivalent control mechanism for networks is trust." (page 7)6

As Bradach and Eccles explain, "Trust is a type of expectation that alleviates the fear that one's exchange partner will act opportunistically." "Trust is an important lubricant of social system. It is extremely efficient; it saves people a lot of trouble to have a fair degree of reliance on other people's word." (page 282)7 Levin and colleagues find that "... when it comes to knowledge sharing, trusting people's benevolence consistently matters, but trusting their competence is even more important when the knowledge is difficult to codify." (page 6).8

Networks have always been intrinsic to health services, epitomised by professional associations and referral networks, although rarely adequately recognised. In the United States, hierarchical control and integration have been championed by health service theorists, despite the increasing prevalence of networks. …

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