Best Allan, Berland Alex, Greenhalgh Trisha, Bourgeault Ivy L, Saul Jessie E, Barker Brittany
InSource Research Group, Coquitlam, Canada.
School of Population and Public Health, University of British Columbia , Vancouver, Canada.
J Health Organ Manag. 2018 Mar 19;32(1):9-24. doi: 10.1108/JHOM-06-2017-0129. Epub 2018 Jan 2.
Purpose The purpose of this paper is to present a case study of the World Health Organization's Global Healthcare Workforce Alliance (GHWA). Based on a commissioned evaluation of GHWA, it applies network theory and key concepts from systems thinking to explore network emergence, effectiveness, and evolution to over a ten-year period. The research was designed to provide high-level strategic guidance for further evolution of global governance in human resources for health (HRH). Design/methodology/approach Methods included a review of published literature on HRH governance and current practice in the field and an in-depth case study whose main data sources were relevant GHWA background documents and key informant interviews with GHWA leaders, staff, and stakeholders. Sampling was purposive and at a senior level, focusing on board members, executive directors, funders, and academics. Data were analyzed thematically with reference to systems theory and Shiffman's theory of network development. Findings Five key lessons emerged: effective management and leadership are critical; networks need to balance "tight" and "loose" approaches to their structure and processes; an active communication strategy is key to create and maintain support; the goals, priorities, and membership must be carefully focused; and the network needs to support shared measurement of progress on agreed-upon goals. Shiffman's middle-range network theory is a useful tool when guided by the principles of complex systems that illuminate dynamic situations and shifting interests as global alliances evolve. Research limitations/implications This study was implemented at the end of the ten-year funding cycle. A more continuous evaluation throughout the term would have provided richer understanding of issues. Experience and perspectives at the country level were not assessed. Practical implications Design and management of large, complex networks requires ongoing attention to key issues like leadership, and flexible structures and processes to accommodate the dynamic reality of these networks. Originality/value This case study builds on growing interest in the role of networks to foster large-scale change. The particular value rests on the longitudinal perspective on the evolution of a large, complex global network, and the use of theory to guide understanding.
目的 本文旨在呈现世界卫生组织全球卫生人力联盟（GHWA）的一个案例研究。基于对GHWA的委托评估，运用网络理论和系统思维的关键概念，探讨该联盟在十年期间的网络形成、有效性及演变。该研究旨在为全球卫生人力资源（HRH）治理的进一步发展提供高层次的战略指导。
设计/方法/途径 方法包括对HRH治理的已发表文献及该领域当前实践的回顾，以及一项深入的案例研究，其主要数据来源是相关的GHWA背景文件以及对GHWA领导人、工作人员和利益相关者的关键 informant 访谈。抽样是有目的的且针对高层，重点是董事会成员、执行董事、资助者和学者。参照系统理论和希夫曼的网络发展理论对数据进行主题分析。
发现 得出了五个关键经验教训：有效的管理和领导至关重要；网络需要在其结构和流程上平衡“紧密”和“宽松”的方法；积极的沟通策略是创造和维持支持的关键；目标、优先事项和成员资格必须仔细聚焦；并且网络需要支持对商定目标的进展进行共享衡量。当以复杂系统的原则为指导时，希夫曼的中程网络理论是一个有用的工具，这些原则阐明了随着全球联盟的演变动态情况和变化的利益。
研究局限性/影响 本研究是在十年资助周期结束时实施的。在整个期间进行更持续的评估会对问题有更丰富的理解。未评估国家层面的经验和观点。
实际意义 大型复杂网络的设计和管理需要持续关注领导等关键问题，以及灵活的结构和流程以适应这些网络的动态现实。
原创性/价值 本案例研究建立在对网络在促进大规模变革中作用的兴趣日益增长的基础上。其特殊价值在于对一个大型复杂全球网络演变的纵向视角，以及运用理论来指导理解。
