Network governance forms in healthcare: Empirical evidence from two Italian cancer networks

Abstract Background: The study focuses on the application of a well known framework of networks governance modes to the specific field of healthcare public networks, extending the framework to the analysis of systems in which networks are involved. The aim of the study is to identify which contextual factors (internal and external to the networks) of different governance modes are critical for network effectiveness. Methods: A qualitative study of two clinical networks belonging to 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.Results: Our study confirms the general validity of Provan and Kenis’ framework and shows how other specific factors and contingencies may affect the possibility of the two cancer networks finding positive equilibria between competing needs of inclusivity and efficiency, internal and external legitimacy, stability and flexibility. Concerning the first tension, our study shows the importance of distinguishing the professional inclusiveness of the organizational inclusiveness with respect to which of the two networks are characterized by different components. In both a critical role is played by a professional figure who acts as the network broker in managing the legitimacy tension, although the nature of the role actually played and the characteristics of individuals appear to be different. Few differences across networks are shown about the third tension in respect to which both networks are characterized by the network governance’s stability although both were involved in two Italian regions that underwent healthcare system reconfiguration.Conclusions: Our study shows the importance of considering three factors and contingencies that may affect network effectiveness: a) the importance of looking at the networks governance modes not in isolation, but in close relationship to the regional systems’ governance; b) the influence of the specific network governance structure on the capability of the network to respond to tensions and achieve its goals; and c) the need to take into due account the role of professionals in network governance.