Understanding the conditions that lead to effective health services delivery networks.

This commentary addresses four of the paradoxes proposed by Huerta et al.--resourcing, synergy, defragmentation and evaluation--and uses recent evidence from the Ontario Regional Stroke Strategy and the Dementia Care Networks Study to explore the challenges identified in greater depth. Seven strategies are also proposed to advance the practice and research agendas related to network development and evaluation: developing a shared vision of care for particular groups of care recipients/clients, products and services that goes beyond a single sector (e.g., acute care only); identifying the aspects of care that will most likely benefit from a network structure; embedding networks within broader strategies; developing both clinical and management leadership and collaborations at the organizational and network levels; developing mechanisms to understand care-recipient flow and where gains can be achieved through interactions of key organizations and service providers; using administrative and information mechanisms to increase efficiencies within networks; and acknowledging that, even with a centralized strategy, variations will exist between similar networks.