Critical Factors for the Quality of Collaboration
Case study of a healthcare network
When policy issues are too complex for a single actor to deal with, it is common that governmental organisations find a way to collaborate with other actors. The networks that arise are called governance networks. Many of these governance networks arose in the Netherlands after the decentralisation of the homecare and guidance of elderly and disabled people, the participation law and youth care in 2015. Collaboration can be difficult in governance networks, but is especially important when health care services for citizens are dependent upon it. In order to improve future collaboration, it is important to know what factors can influence the collaboration in governance networks. This research is a case study of the KrimpenWijzer network, which was created in the municipality of Krimpen aan den IJssel after the decentralisation. The research question is: ‘What are critical factors in the collaboration processes within governance networks and which of these factors can be used to explain the quality of the collaboration in the KrimpenWijzer?’. To answer this research question first a literature study is conducted, forming a theoretical framework with the most relevant scientific concepts. In this framework different types of governance networks and network governance are discussed, which show that it differs per type what the collaboration process should be focussed on. To assess the quality of the collaboration four indicators are selected: trust, commitment, common goal/vision and sharing information. After a comparison of different sources on collaboration in governance networks, three possible factors that influence the quality of the collaboration are selected: leadership, starting conditions and institutional design. These indicators and factors are all operationalised to make them measurable. As said, this research is a case study. The KrimpenWijzer case was chosen because it meets the requirements of a governance network and because of the access the author has to the actors in this network. Data was collected via semi structured interviews, using the theoretical concepts to guide the interviews, but also leaving room for other possible factors that influence the quality of the collaboration. Two respondents per organisation participating in the network were interviewed, with an exception of the wmo department of the municipality (where only one respondent was interviewed). Furthermore, two process directors and a manager working for the municipality were interviewed to look at the collaboration from a more distant perspective. Lastly, also someone of an organisation outside the KrimpenWijzer was interviewed, to see how the collaboration in the network is seen from the outside. This leads to a total of fourteen interviews, all transcribed and coded to make a transparent analysis. The KrimpenWijzer is a governance network, focussed on providing healthcare services. The network was created in 2015 by the municipality to deal with the decentralisations. There are five organisations participating in the network (Kwadraad, MEE, CJG, ContourdeTwern and different departments of municipality) and there is one process director who guides the collaboration processes in the network. To keep municipal control this process director is employed by the municipality. The KrimpenWijzer can be seen as a service delivery network, with a lead organisation type of network governance. The leading organisation is the municipality of Krimpen aan den IJssel. Assessing the quality of collaboration in the network is done by asking questions on the four indicators deriving from theories, but also by asking actors how they perceive ‘good collaboration’. It turns out that a low threshold for contact is also seen as an important indicator to assess the quality of the collaboration. Some aspects of the collaboration are positively assessed, like the high level of trust and the low threshold for contact, but for others there is still room for improvement. The levels of common goal/vision and sharing information are moderate and the level of commitment is even low. This leads to an overall assessment of a moderate quality of collaboration in the KrimpenWijzer. All the factors from theories that are taken into account in this research are relevant in explaining this quality of the collaboration. The lack of a clear leader in the network has a negative impact on the common goal/vision and commitment. Because of the absence of a leading organisation the collaboration does not move past the point of simply sharing the information necessary for service delivery. A practical recommendation is to rearrange the tasks of the process director. In this way, she can prioritize the collaboration process between the participating actors in the KrimpenWijzer and emphasize the need for collaboration to achieve the common goal. The empirical research shows that her efforts to facilitate a productive group dynamic lead to more information sharing and trust. The starting conditions led to less commitment and common goal/vision but lowered the threshold for contact. In the beginning the municipality was not able to clearly explain why they decided to create this network. This led to the actors not seeing the common goal and therefor also not feeling committed to the collaboration process. It might be useful if the municipality would put more effort into explaining the idea behind the collaboration so the relevance of the collaboration becomes more clear to the actors. Whether the starting conditions have a negative or positive effect on trust differs per person and the relationship the actors already had with the others. The institutional design of the network provides a strong basis for the collaboration. It only has positive effects on the quality of the collaboration, improving the level of trust, information sharing, commitment and the low threshold for contact. Next to these three factors, there are three more factors that turn out to be of influence on the quality of the collaboration in the KrimpenWijzer. The first is the high employee turnover over the past 18 months, having a negative impact on the level of trust, common goal/vision, information sharing and low threshold for contact. Employees do not know each other that well anymore and it takes time to build relationships again. It also takes time for the new employees to see the common goal of the collaboration in this network. The second factor is the high workload, having a negative effect on commitment and information sharing. Actors do not have the time to fully commit to the collaboration process and act more on their own islands instead of sharing information with other actors. Lastly, the relationship with the mother organisation has a negative effect on the common goal/vision in the network. Especially in the beginning it was difficult for the employees to have a mother organisation with a goal and vision, but also the municipality having a vision on how the collaboration should work in the network. Reflecting on these results, there seems to be a mismatch between the current type of network governance (lead organisation type) and the type of governance the municipality wants the network to be (shared governance type). This could explain why the different factors influence the indicators of collaboration as they do now, but why the respondents of the municipality are not happy about it and why there is still so much space for improvement. Suggestions for further research would be to repeat this study in similar healthcare governance networks to see if the same factors are of influence on the quality of the collaboration. Another suggestion is to compare theories from healthcare studies about collaboration with public administration theories, to see what the differences are and where they could be combined. It might be possible that collaboration theories focussed on the healthcare sector come up with different factors that influence the collaboration process.
|Thesis Advisor||Prof.dr. J.F.M. Koppenjan, Prof.dr. H.J.M. Fenger|
Lagemaat, Nicky van de. (2020, February 25). Critical Factors for the Quality of Collaboration. Public Administration. Retrieved from http://hdl.handle.net/2105/51211