Reading: Leading networks in healthcare: Health Foundation Learning Report

Health Foundation Learning report:(full report here)

Leading networks in healthcare: Learning about what works – the theory and practice

Published 23 January 2013

This is report is based on the programme the Health Foundation set up in October 2011 to support 30 diverse networks in healthcare around the UK with local, regional and national remits (full list at the bottom).  They sought to combine real life experience with a range of theory and knowledge about how to make networks successful.  The work is ongoing.  They hope this will inform understanding of how change can happen at scale.

They’d noted an increased number of networks, affected by redefined organisational boundaries, increasing interdependence between organisations to integrate care, networks attempting to solve complex apparently intractable problems, growth of professional and social networking tools, and increased notice and therefore visibility of networks.  Interviews with network leaders suggested the knowledge and theory about networks was ‘remote and inaccessible’.

Each participating network underwent a diagnostic exercise and co-designed a support plan with the faculty of independent consultants.  These plans were in the early stages of implementation by July 2012.  The networks represented the range of development stages: Pre-emergent, emerging, established and dormant.  Some were formalised, other organic and some run by individuals in their spare time.

What we know about networks

The Health Foundation undertook 2 brief literature reviews.

Networks are “cooperative structures where an interconnected group, or system, coalesce around shared purpose and where members act as peers on the basis of reciprocity and exchange, based on trust, respect and mutuality.” (p.8)  They tend to exist dynamically, with different leadership emerging for different work.

They are distinctive because they:

• foster innovation and creativity – relying on diversity
• distribute power and leadership
• are based on mutual interest around a common purpose
• have fluctuating engagement and impact
• are adaptable
• focus on generating and sharing knowledge
• must be managed in collaborative, non-hierarchical ways
• operate outside the traditional structures

The primary functions of networks are community building, filtering information, amplifying ideas, facilitating, investing or providing resources, and convening and supporting (Medizabal and Hearn cited on p.9).

The six main categories of networks are:

1. Developmental or learning network:  focussing on specific issues e.g. AQuA, CoPs, Collaboratives
2. Agency network: cooperative and shared services e.g. Shared Lives Plus
3. Advocacy network: championing change / shared cause e.g. Parkinson’s Action Network
4. Managed network: Hub and spoke service delivery model e.g. Diabetes Research Network
5. Social network: individuals learning, connecting, visible and supportive e.g. LinkedIn, Twitter
6. Social movement: common cause for campaigning e.g. the Occupy movement

In practice networks may be hybrids, though “structures and ways of operating do need to be aligned with the type of network they aspire to be” (p.11).

Network leadership is “facilitative, distributed, democratic and inclusive, and making the most of difference for creative ends… and need[s] to focus persistently on membership and impact.” (p.11)

What makes networks effective?

• Shared purpose and identity: strong network identity and sense of shared purpose and ownership demonstrated through a common language and narrative.
• Addressing big issues or having a compelling purpose: ‘being’ a high priority.
• Meets members’ needs: provide day-to-day benefit
• Adapted leadership: skilled non-hierarchical leaders with time
• Strong relationships and ties: high levels of personal trust, role-modelled by leaders
• Generate helpful outputs

What factors affect network failure?

• Insufficient shared understanding of purpose and direction
• Institutionalisation, with a tendency to control excessively and manage towards homogeneity
• Over-managed, with burdensome governance and bureaucracy
• Poor initial design
• Unrealistically high expectations of members’ willingness or ability to collaborate
• Prioritising some members’ interests over others
• Constraint on members’ independence
• Lack of recognition of when leadership needs to change or rotate
• Insufficient impact in fulfilling the purpose
• Failure to recognise the breadth and depth of different kinds of knowledge

The impact of health networks on quality improvement

The literature review identified “little evidence on the impact of networks in the health sector, and the overall potential of network in the NHS landscape is relatively untested in terms of impact on patient care and governance.” (p.13)  However, the emergence of networks reflects the NHS “adapting to increasingly complex care issues that transcend organisational boundaries”. (p.13)

Employee networks research shows social and informal networks allow greater information flow than hierarchies, and social media can improve healthcare provision.

Tips for network leaders:

• Building consensus takes time, but its worth it (Iain Smith, NETS)
• Face-to-face is essential but needs to be kept fresh, varied and not overloaded (Iain smith, NETS)
• Passion counts more than leadership style (Iain Smith, NETS)
• Know what you’re setting out to achieve, be self-critical and continually revisit your goals (Richard Thomson, NESDMCI)
• Central skilled resource is essential (Richard Thomson, NESDMCI) and Forget the need for administrative support at your peril (Miranda Wolpert, CAMPHS EBPU)
• Diversity in membership can be one of your biggest assets – including patients (Richard Thomson, NESDMCI)
• Make it as easy as possible for people to join in (Peter Lachman, HF QI Alumni)
• Don’t wait for groundswell: gather a few likeminded people and see if momentum builds (Paul Nash, PCN)
• Be ambitious in the long term, but realistic in the short term.  Don’t wear people out by expecting too much.  Always stay mindful that they have a day job to do. (Paul Nash, PCN)
• It’s ok to model failure and to show that it’s not a big deal (Miranda Wolpert, CAMPHS EBPU)
• Communicate, communicate, communicate (Miranda Wolpert, CAMPHS EBPU)

What leaders wish they knew:

• The magic ingredient that turns someone into an advocate overnight (Iain Smith, NETS)

Ideas worth stealing:

• ‘Flipchart road show’ – delegates write their ‘problem’ on a flipchart.  Everyone circulates for 45 minutes to discuss the issues. (Iain Smith, NETS)
• Ask for freebies, share resources and piggyback other events. (Iain Smith, NETS)
• Always identify a product or take-home message or action (Richard Thomson, NESDMCI)
• Use a range of social media – not everyone uses a specific one (Peter Lachman, HF QI Alumni)
• Ask constantly why some members do not participate and reach out to them (Peter Lachman, HF QI Alumni)
• Initiate new projects that meet a shared need… the resources produced help newer members see that it’s not just a talking shop (Paul Nash, PCN)

Appendices include:

–          Further reading about networks

–          Glossary of network terms

List of participating networks: