Networks have become the flavour of our time as ‘wicked problems’ (large, messy, complex and systemic) require multi-stakeholder actors to work together to find a common solution. But how feasible are networks within the institutional contexts they are expected to function? An attempt to answer this question led one into an array of perspectives not only of networks but also about collaboration, which is seen as the ‘very essence’ of networks. Meanwhile, a developing insight is that to be successful, networks will have to be context specific, but useful learning can come from elsewhere where network implementation is advanced – since core elements of collaboration such as trust, social capital, reciprocity are human nature.

1. Researching Networks /
Collaboration: reflections of a
novice
~ Tarry Asoka
Institute for Public Policy & Management
Keele University, Staffordshire, UK

2. Outline
 The promise of Networks
 Conceptual difficulties
 Framing a research question
 Concept/theory selection
 Empirical work relevant to my interests

3. The Promise of Networks
So much expectations:
- Governance mechanisms to solve complex
problems or resolve critical issues
- Integration of care across time, settings, providers
- Means of efficient resource allocation – GPs as
coordinators of inputs
Managed Clinical Networks in UK, Australia etc.
But can the Network deliver?
Is the Network a feasible form of healthcare delivery
in Developing Countries? (Nigeria?)

4. Managed Clinical Networks:
“linked groups of health professionals and
organisations from primary, secondary, and
tertiary care working in a co-ordinated manner,
unconstrained by existing professional and
[organisational] boundaries to ensure equitable
provision of high quality effective services”
(Scottish Executive Health Department, 2002)

5. Conceptual Difficulties
What is a network? – can we define it? Can we
measure it?
But disciplinary claims to the use of the term –
networks mean different things to different people.
Whose perspective is important? Does it matter?
Researcher's Preference: a set of nodes (individuals or
organisations) and relationships (friendships or
sharing of resources) which link them together
(Laumann et al., 1978; Fombrun, 1982)
Even then different perspectives persist

6. (Klijn, 2008, p122) - 3 distinct forms of Network:
Policy networks - utilise the network approach for
decision-making and consensus building among
various interest groups.
Inter-organisational service delivery/ implementation
networks - use networks as vehicles for service
delivery and implementation of policies.
governance networks - as a mechanism for resolving
“value conflicts that are at stake when actors try to
achieve workable solutions for policy problems”.

7. Social network insights: Relationships & Structural
Forms (patterns & positions)
Intra-organisational networks - the sort of
relationships that exist between individuals inside
organisations (Raider and Krackhardt, 2002)
Egocentric networks - the “focal organization’s
pattern of relationships with other organizations in
the same network” (Gulati et al., 2002, p. 281)
Inter-organisational network - an organisational form
whereby the entire set of relationships are
integrated into a ‘whole’ that necessarily have to
perform as a unit (Baker and Faulkner, 2002)

8. Social and Professional networks : relationships
among individuals in inter-organisational networks,
whereby the interactions carry the mandate or
recognition of the organisations involved. But
Facebook: social networks - communities of
individuals, who share common interests and / or
activities, or who are interested in exploring the
interests and activities of others; OR
LinkedIN: professional networks - focus on
interactions and relationships of a business or
professional nature.
(Bernard et al, 1990; Degenne and Forse, 1999;
Dawson , 2003; Arthur and Rosseau, 1996).

9. Some more viewpoints:
Alter and Hage (1993) - Networks as constituting the
basic social form that allow inter-organisational
interactions for the purpose of exchange, taking
concerted action and joint production among
member organisations.
Trevillion (1999) - Networks perceived as exchange
systems whereby the linkages serve as conduits for
the flow of information and resources.
Provan and Milward (2001) – Networks as a collection
of programs and services that span a broad range of
cooperating but legally autonomous organisations.

10. Understanding Networks is work in
progress:
Despite the plethora of network
meanings, there are still limitations to
our capacity to describe networks
precisely, as well as our ability to
create boundaries around them.

11. Framing a Research Question
So many potential lines of inquiry broadly:
 Why do organisations join networks? And in what
ways do network members co-operate?
 What health problems (care processes) do they
address? And what resources or knowledge do they
share?
 What contributions do network members make to
network activities? And what benefits do they
derive from network participation?
 Do networks achieve what they set out to do?

12. But networks do not exist in Isolation – they operate
within an institutional framework, in which they
seek to establish and maintain legitimacy (Scott,
1995). If so:
What conditions are required for networks to
function properly?
***
What learning comes from the process of
implementing networks in the UK NHS that can be
useful to developing country setting?
***
Is the network a feasible form of healthcare delivery
in Nigeria?

13. Conceptual Framework and
Theory Selection
 No developed Network Theory
 Researchers and practitioners relied on two
organisational theoretical perspectives – resource
dependence and transaction cost economics.
 But “each perspective focuses essentially on the
organizational antecedents and outcomes of
network involvement, with little attention paid to
the network as a whole, except for its governance
and structure” (Provan and Milward 1995, p. 1)
 Assumptions, Other Perspectives and Models

14. Assumptions:
 Clinical networks will produce better health
outcomes through service coordination
 Collaboration is the very essence of clinical
networks
Some relevant perspectives of collaboration -
 Collaboration as means of gaining ‘collaborative
advantage’
 Collaboration as mechanism for solving complex
problems
 Collaboration as a means of building social capital

15. Models of Collaboration for practice
Himmelman’s framework - presents collaboration as
a dynamic and an evolving process – from
networking, cooperating, and coordinating to
collaborating (Himmelman, 1996)
D’Amour’s structuration model of collaboration -
collaborative actions can be analysed in terms of four
inter-related dimensions that influence each other -
shared goals and vision, internalisation, formalisation,
and governance. (D’Amour et al 2008)
Nollywood Paradigm (Nigeria Home Movie Industry)
- successful ‘communities of practice’ in Nigeria

16. Empirical work relevant to my
interests
Research interest:
To examine existing “naturally - occurring’ forms of
collaboration where team-based collaboration is likely
such as HIV/AIDS Programme Teams in Nigeria - as
the basis for testing the feasibility of the network
model of healthcare service delivery in a developing
country setting.
Research Strategy:
Case study of HIV/AIDS Programme Clusters in Rivers
State, Nigeria

17. Selecting and Reviewing the Body of Empirical Work:
Knowledge about power
Knowledge
about MCN
Knowledge about
managed network,
public service,
private businesses etc
Knowledge about networks,
organisations, and management

18. Emerging findings from this case study
being tested against theory and empirical
practice from the UK NHS and elsewhere
to assess the feasibility of clinical networks
in Nigeria.
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