Department of Experimental and Clinical Medicine, Health Services Research Unit, University of Florence, Florence, Italy.
SDA Bocconi, Bocconi University, Milan, Italy.
BMC Health Serv Res. 2020 Nov 9;20(1):1018. doi: 10.1186/s12913-020-05867-2.
This study focuses on the application of Provan and Kenis' modes of network governance to the specific field of public healthcare networks, extending the framework to an analysis of systems in which networks are involved. Thus, the aim of this study is to analyze and compare the governance of two cancer networks in two Italian regions that underwent system reconfiguration processes due to reforms in the healthcare system.
A qualitative study of two clinical networks in the Italian healthcare system was conducted. The sample for interviews included representatives of the regional administration (n = 4), network coordinators (n = 6), and general and clinical directors of health organizations involved in the two networks (n = 25). Data were collected using semi-structured interviews.
Our study shows that healthcare system reforms have a limited impact on network governance structures. In fact, strong inertial tendencies characterize networks, especially network administrative organization models (NAO). Networks tend to find their own balance with respect to the trade-offs analyzed using a mix of formal and informal ties. Our study confirms the general validity of Provan and Kenis' framework and shows how other specific factors and contingencies may affect the possibility that cancer networks find positive equilibria between competing needs of inclusivity and efficiency, internal and external legitimacy, and stability and flexibility. It also shows how networks react to external changes.
Our study shows the importance of considering three factors and contingencies that may affect network effectiveness: a) the importance of looking at network governance modes not in isolation, but in relationship to the governance of regional systems; b) the influence of a specific network's governance structure on the network's ability to respond to tensions and to achieve its goals; and c) the need to take into account the role of professionals in network governance.
本研究将 Provan 和 Kenis 的网络治理模式应用于公共医疗网络的特定领域，将框架扩展到涉及网络的系统分析。因此，本研究旨在分析和比较两个意大利地区癌症网络的治理情况，这两个网络都经历了医疗保健系统改革引发的系统重新配置过程。
对意大利医疗保健系统中的两个临床网络进行了定性研究。访谈的样本包括地区行政部门的代表（n=4）、网络协调员（n=6）以及参与两个网络的卫生组织的普通和临床主任（n=25）。使用半结构化访谈收集数据。
我们的研究表明，医疗保健系统改革对网络治理结构的影响有限。事实上，网络具有很强的惯性趋势，尤其是网络行政组织模式（NAO）。网络倾向于在使用正式和非正式联系的组合来分析权衡的情况下找到自己的平衡。我们的研究证实了 Provan 和 Kenis 框架的普遍有效性，并展示了其他特定因素和意外情况如何影响癌症网络在包容性和效率、内部和外部合法性、稳定性和灵活性等竞争需求之间找到积极平衡的可能性。它还展示了网络如何对外部变化做出反应。
我们的研究表明，考虑三个可能影响网络有效性的因素和意外情况很重要：a）重要的是不仅要孤立地看待网络治理模式，还要将其与区域系统的治理联系起来；b）特定网络的治理结构对网络应对紧张局势和实现其目标的能力的影响；c）需要考虑专业人员在网络治理中的作用。
