Across all organisations there is a global movement from hierarchies to highly networked forms. As the world becomes more global, and problems more complex organisations are working together in (multiple) networked systems. Organisations will have at minimum learning partners working together in learning networks; delivery partners working together to deliver services across populations.
Innovation requires collaboration.
Integrated Care systems can be delivered more effectively through a network model. This approach needs to bring multiple delivery partners together to collaborate as peers to deliver innovations in services, and to learn together. These ‘Developmental’ networks (Malby & Mervyn 2012) are good at focusing effort at a system level and enabling collaborations between organisations where there is no one accountable organisation and where members redesign together. Leadership here is systems leadership. Accountability and governance now rests at two levels – with organizational member boards for their own financial and clinical responsibilities, but also to/with the other network members for delivery of the whole. This approach should bring flexibility and adaptability.
However these models will fail if they are performance managed as a hierarchy. Where the work requires innovation, collaboration, learning and adaptation networks will deliver. However if there is a ‘master plan’ that requires implementing then networks will not deliver.
The confusion over the Sustainability and Transformation Plans reflect this. If STPs are a planning mechanism then a hierarchical model is needed with individual organisations relinquishing authority to an executive leadership group (a group model). If it requires agility and emergent innovation a network form is the better option, but this does require sophisticated systems leadership as peers (see the attached resource on systems leadership).
Another emerging form of network is the GP Federation, providing a population based organizational form for innovation and economies of scale. Members commit to the Federation to secure member benefits for population health gain, and where they work well, to negotiate as a collective and learn together.
For these networks made up of organisations with strong hierarchies the pitfalls relate to the usual issues in networks – that whilst they can be agile and creative forms they take effort to develop the relationships, they can’t solve capacity problems (at the outset, they can as they begin to innovate together), they can have a complex decision-making process, and they are dependent on agreements between members being binding.
Where they work well there is a clear commitment and interest in the collective outcome, they invest in members who can understand multiple members views and can bring those views and issues together facilitating inter-group relationships and surface and work with inter-group conflict. A the core is the agreed task of the network.
Malby, R., Mervyn, K. (2012) Networks – A briefing paper for The Health Foundation. University of Leeds.