Network resilience in the face of health system reform
Network resilience in the face of health system reform
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DOI：
10.1016/j.socscimed.2009.11.011
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发表时间：
2010-03-01
影响因子：
5.4
通讯作者：
Reeves, David
中科院分区：
文献类型：
--
作者：
Sheaff, Rod;Benson, Lawrence;Reeves, David
许多卫生系统现在使用网络作为治理结构。网络“大文化”是人工制品的复合体，支持的价值观和未阐明的假设，通过网络成员协调网络活动。因此，了解2006-2008年期间网络宏观文化的发展情况，对于理解卫生网络如何运作、卫生系统改革如何影响它们以及网络如何作为治理结构发挥作用（和可以利用）具有重要价值。为了研究准市场改革如何影响卫生网络的宏观文化，我们系统地比较了英国NHS的两个护理网络、一个项目网络和一个用户体验网络中这些影响的纵向案例研究。我们对关键线人、焦点小组进行了访谈，对会议进行了非参与者观察，并对关键文件进行了分析。我们发现，在这些网络中，人工制品适应卫生系统改革的速度比信奉的价值观，后者适应更快的基本假设。这些研究结果有助于知识提供实证支持的理论，认为网络的核心实践活动的变化是什么刺激网络宏观文化的其他方面的变化。因此，利用网络宏观文化来管理卫生网络的形成和运作的最有力的方式似乎是将管理活动集中在网络产生其核心人工制品的方式上。(C)2009爱思唯尔有限公司版权所有。
Many health systems now use networks as governance structures. Network 'macroculture' is the complex of artefacts, espoused values and unarticulated assumptions through which network members coordinate network activities. Knowledge of how network macroculture during 2006-2008 develops is therefore of value for understanding how health networks operate, how health system reforms affect them, and how networks function (and can be used) as governance structures. To examine how quasi-market reforms impact upon health networks' macrocultures we systematically compared longitudinal case studies of these impacts across two care networks, a programme network and a user-experience network in the English NHS. We conducted interviews with key informants, focus groups, non-participant observations of meetings and analyses of key documents. We found that in these networks, artefacts adapted to health system reform faster than espoused values did, and the latter adapted faster than basic underlying assumptions. These findings contribute to knowledge by providing empirical support for theories which hold that changes in networks' core practical activity are what stimulate changes in other aspects of network macroculture. The most powerful way of using network macroculture to manage the formation and operation of health networks therefore appears to be by focusing managerial activity on the ways in which networks produce their core artefacts. (C) 2009 Elsevier Ltd. All rights reserved.