Skip to main content
SpringerLink
Log in

Integrating Health in All Policies at the Local Level: Using Network Governance to Create ‘Virtual Reorganization by Design’

  • Chapter
  • First Online:
Policy Innovation for Health

Abstract

The thesis of this chapter is that the Health in All Policy innovation process is only complete when national intentions have linked up with, and made a change to, ‘practice’ at the local level. Much is known about the way bureaucratic hierarchies attempt, but often fail, to make this happen, but much less so in relation to networks. For the latter, evidence is presented showing their superiority when policies are complex, requiring cross organizational action, and when the potential effort directed to their achievement is fragmented.

In the case of HiAP both situations apply. However, in the dialog between 26 of 32 countries meeting in Finland in 2006 to consider obstacles and driving forces in relation to HiAP, it is remarkable that no consideration is given to the possibility that the very nature of organizations, and what they represent to those who work in them, might be a root cause of the many years of relative failure to bring about multisectoral, interorganizational action.

Directed specifically toward improvement of interorganizational relationships, the chapter focuses on arrangements that can be put in place to overcome barriers to integrative action. These may be structural, procedural, financial, professional, or relate to status and legitimacy.

Ultimately, the aim is to achieve virtual reorganization, with the design of bringing together interorganizational effort to achieve health and social gain targets. This is Policy Innovation Number 1.

The journey to this end involves an understanding of what will:

  • bring a diverse range of organizations to the table to form networks – using resources better, gaining wider skills, sharing risk and uncertainty, adaptive efficiencies, and legal or regulatory demands, and

  • the crucial elements involved in network development if success is to be assured – the right choice of network type, relating to complexity of the problem, the specialist knowledge required, size, etc; an understanding of the organizational cultures of members; communication arrangements; and good governance.

This is Policy Innovation Number 2.

The chapter also introduces the ‘neutral white space’ concept – a zone between participating organizations where they can meet in an unfettered, less guarded way. Coordination of activity is key; and a particular role is described which involves ‘attracting’, ‘guiding,’ and brokering white space and virtual reorganizations’ activities, that is working with networks in the space and assisting in mainstreaming the results of their creative thinking. This is Policy Innovation Number 3.

The evidential base which enabled the above approach to be developed was tested in an extensive 4-year action research project in South Wales, UK. This is reported here in case study form as a self-standing item at the end of the chapter. Policies which might provide a better quality of life and health for older people were developed through coordinated networks concerned with crime, transport, income and medication, and implemented by the partner organizations working in a virtually reorganized way.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Morgan, G., 1996. Images of Organisations. Beverly Hills: Sage.

    Google Scholar 

  2. Council of the European Union, 2006. Council Conclusions on Health in All Policies (HiAP). Brussels: Council of the European Union.

    Google Scholar 

  3. Ståhl, T., Lahtinen, E., & Wismar, M., 2006. Report of the Policy Dialogues. The Finnish EU Presidency Projects in “Europe for Health and Wealth 2006”. Unpublished report. Helsinki.

    Google Scholar 

  4. World Health European Office, 1984. HFA by the year 2000: European Regional Targets. Copenhagen: WHO.

    Google Scholar 

  5. Ståhl, T., & Lahtinen, E., 2006. Towards closer intersectoral cooperation: The preparation of the Finnish national health report. In T. Ståhl et al. (eds) Health in All Policies, Prospects and Potentials, pp. 169–191. Finland: Ministry of Social Affairs and Health.

    Google Scholar 

  6. Sihto, M., Ollila, E., & Koivusalo, M., 2006. Principles and challenges of Health in All Policies. In T. Ståhl et al. (ed.) Health in All Policies, Prospects and Potentials, pp. 3–20. Finland: Ministry of Social Affairs and Health.

    Google Scholar 

  7. Ritsatakis, A., & Järvisalo, J., 2006. Opportunities and challenges for including health components in the policy-making process. In T. Ståhl et al. (eds) Health in All Policies, Prospects and Potentials, pp. 145–168. Finland: Ministry of Social Affairs and Health.

    Google Scholar 

  8. Dahlgren, G., & Whitehead, M., 1991. Policies and Strategies to Promote Social Equity in Health. Stockholm: Institute of Futures Studies.

    Google Scholar 

  9. Swedish National Institute of Public Health, 2003. The National Public Health Strategy for Sweden in Brief. Stockholm: Swedish National Institute of Public Health.

    Google Scholar 

  10. Agren, G., 2003. Sweden’s New Public Health Policy: National Public Health Objectives for Sweden. Sandviken, Sweden: Sandvikens tryckeri.

    Google Scholar 

  11. Lager, A., Guldbrandsson, K., & Fossum, B., 2007. The chance of Sweden’s public health targets making a difference. Health Policy, 80, 413–421.

    Article  PubMed  Google Scholar 

  12. Kickbush, I., 2003. The contribution of the World Health Organisation to a new public health and health promotion. American Journal of Public Health, 93(3), 383–388.

    Article  Google Scholar 

  13. Nilsson Carlsson, I., 2005. In Proceedings of the Interfaculty Working Group on Health Disparities. Cambridge, Mass: Harvard Public Health Now, 18th March.

    Google Scholar 

  14. Fine, M., Pancharatnam, K., & Thomson, C., 2005. Coordinated and Integrated Humans Service Delivery Models. SPRC Report 1/05, University of New South Wales, Sydney: Social Policy Research Centre.

    Google Scholar 

  15. Integrated Care Network, 2004. Change Agent Report 1-12 www.integratedcarenetwork.co.uk

  16. Woods, K., 2001. Development of integrated health care models. International Journals of Integrated Care. 1. April-June. http://www.ijic.org/archive.html

  17. Hardy, B., Mur-Veemanu, I., Steenbergen, M., & Wistow, G., 1999. Inter-agency services in England and the Netherlands. A comparative study of integrated care development and delivery. Health Policy, 48, 87–105.

    Article  PubMed  CAS  Google Scholar 

  18. Jones, C., Hesterly, W.S., & Borgatti, S.P., 1997. A general theory of network governance: Exchange conditions and social mechanisms. Academy of Management Review, 22(4), 911–945.

    Google Scholar 

  19. Burt, R., 1992. Structural Holes: The Social Structure of Competition. Cambridge, MA: Harvard University Press.

    Google Scholar 

  20. Warner, M., 2006. Synergy. In M. Marinker (ed.) Constructive Conversations About Health, Policy and Values. Oxford: Radcliffe Publishing.

    Google Scholar 

  21. Tillich, P., 1926. Religiöse Verwicklichung. Berlin: Furche Verlag.

    Google Scholar 

  22. Tillich, P., 1936. The Interpretation of History. Part one trans. By N.A. Rasetski; part two, three and four trans. By Elsa L Talmey. New York and London: Charles Scribner’s Sons.

    Google Scholar 

  23. Aldrich, H., & Whetten, D.A., 1981. Organization-sets, action sets and networks: Making the most of simplicity. In P.C. Nystrom & W.H. Starbuck (eds) Handbook of Organizational Design. Volume 1: Adapting Organizations to their Environments, pp. 385–408. New York: Oxford University Press.

    Google Scholar 

  24. Milward, H.B., & Provan, K.G., 1998. Measuring network structure. Public Administration, 76(2), 387–407.

    Article  Google Scholar 

  25. Powell, W.W., 1990. Neither market nor hierarchy: network forms of organization. In L.L. Cummings & B. Straw (eds) Research in Organizational Behaviour, pp. 295–336. Greenwich, Connecticut: JAI Press.

    Google Scholar 

  26. Baum, J.A.C., & Oliver, C., 1991. Institutional linkages and organizational mortality. Administrative Science Quarterly, 36, 187–218.

    Article  Google Scholar 

  27. Grandori, A., & Soda, G., 1995. Inter-firm networks: Antecedents, mechanisms and forms. Organization Studies, 16(2), 183–214.

    Article  Google Scholar 

  28. Ebers, M., 1997. The Formation of Inter-Organizational Networks. Oxford: Oxford University Press.

    Google Scholar 

  29. Oliver, C., 1990. Determinants of interorganizational relationships: integration and future directions. Academy of Management Review, 15, 241–265.

    Google Scholar 

  30. Osborn, R.N., & Hagedoorn, J., 1997. The institutionalization and evolutionary dynamics of interorganizational alliances and networks. Academy of Management Journal, 40(2), 261–278.

    Article  Google Scholar 

  31. Hannan, M.T., & Freeman, J., 1984. Structural inertia and organizational change. American Sociological Review, 49, 149–164.

    Article  Google Scholar 

  32. Miles, R.E., & Snow, C.C., 1992. Causes of failure in network organizations. California Management Review, 34, 53–72.

    Article  Google Scholar 

  33. Ibarra, H., 1992. Structural alignments, individual strategies, and managerial action: Elements toward a network theory of getting things done. In N. Nohria & R. Eccles (eds) Networks and Organizations: Structure, Form and Action, pp. 165–188. Cambridge, Massachusetts: Harvard Business School Press.

    Google Scholar 

  34. Warner, M., 2000. Health gain investment for the 21st century: Developments in health for all in Wales. In A. Ritsatakis et al. (eds) Exploring Health Policy Development in Europe, 86, 236–270. Copenhagen: World Health Organisation.

    Google Scholar 

  35. Moreno, J.L., 1934. Who Shall Survive? Foundations of Sociometry, Group Psychotherapy, and Sociodrama. Washington DC: Nervous and Mental Disease Publishing Co.

    Google Scholar 

  36. Kaluzny, A.D., Zukerman H.S., Ricketts III T.C., & Walton G.B., (eds) 1995. Partners for the Dance: Forming Strategic Alliances in Health Care. Ann Arbor, Michigan: Health Administration Press.

    Google Scholar 

  37. Curran, C.R., Kuhn, K.W., Miller, N., Skalla, A., & Thurman, R.D., 1999. Shaping an Integrated Delivery Network: Home Care’s Role in Improving Service, Outcomes and Profitability. Chicago, Ilinois: Health Administration Press.

    Google Scholar 

  38. Hage, J., & Alter, C. A., 1997. Typology of interorganizational relationships and networks, in contemporary capitalism In J.R. Hollingsworth & R. Boyer (eds) The Embeddedness of Institutions, pp. 94–126. Cambridge: Cambridge University Press.

    Chapter  Google Scholar 

  39. Bazolli, G.J., Shortell, S.M., Chan, C., Dubbs, N.L., & Kralovec, P., 1999. A taxonomy of health networks and systems: Bringing order out of chaos. Health Services Research, 33(6), 683–1717.

    Google Scholar 

  40. Shortell, S.M., Bazolli, G.J., Dubbs, N.L., & Kralovec, P., 2000. Classifying health networks and systems: Managerial and policy implications. Health Care Management Review, 25(4), 9–18.

    Article  PubMed  CAS  Google Scholar 

  41. Alter, C., & Hage, J., 1993. Organizations Working Together. Newbury Park, California: Sage.

    Google Scholar 

  42. Hannan, M.T., & Freeman, J. 1989. Organizational Ecology. Cambridge, Massachusetts: Harvard University Press.

    Google Scholar 

  43. Rhodes, R.A.W., 1997. Understanding Governance: Policy Networks, Governance, Reflexivity and Accountability. Buckingham: Open University Press.

    Google Scholar 

  44. Flynn, R., Williams, G., & Pickard, S., 1996. Markets and Networks: Contracting in Community Health Services. Buckingham: Open University Press.

    Google Scholar 

  45. Mintzberg, H., 1979. The Structuring of Organizations. Englewood Cliffs, NJ: Prentice-Hall.

    Google Scholar 

  46. Powell, W.W., 1996. Trust-based forms of governance In R.M. Kramer & T.R. Tyler (eds) Trust in Organizations: Frontiers of Theory and Research, pp. 51–67. Newbury Park, California: Sage.

    Chapter  Google Scholar 

  47. Gulati, R., & Gargiulo, M., 1999. Where do interorganizational networks come from? American Journal Sociology, 104(5), 1439–1493.

    Article  Google Scholar 

  48. Bryant, J., 2002. It’s all threats and promises: Understanding the pressures of effective collaboration, In D. Purdue & M. Stewart (eds) Understanding Collaboration, Proceedings of the 8th International Conference on Multi-organisational Partnerships and Co-operative Strategy, pp. 11–17. Bristol: UWE.

    Google Scholar 

  49. Leavitt, H.J., 1965. Applied organisational change in industry: structural, technological and humanistic approaches. In J.G. March (ed.) Handbook of Organizations, pp. 1144–1170. Chicago: Rand McNally.

    Google Scholar 

  50. Scott, W., 1992. Organizations: Rational, Natural and Open Systems. Englewood Cliffs, NJ: Prentice-Hall, Inc.

    Google Scholar 

  51. Smith, C., Norton, B., & Ellis, D., 1992. Leavitt’s Diamond and the flatter library: A case study in organizational change. Library Management, 13(5), 18–22.

    Article  Google Scholar 

  52. Homburg, C., Workman, J.P. Jr., & Jensen, O., 2000. Fundamental changes in marketing organization: The movement toward a customer-focused organizational structure. Journal of the Academy of Marketing Science, 28(4), 459–478.

    Article  Google Scholar 

  53. Duarte, D.L., & Snyder, N.T., 1999. Mastering Virtual Teams. San Francisco, CA: Josey-Bass.

    Google Scholar 

  54. Ovretveit, J., 1993. Coordinating Community Care. Buckingham: Open University Press.

    Google Scholar 

  55. Nohria, N., & Eccles, R.G., 1992. Face-to-face: Making network organisations work, In N. Nohria & R.G. Eccles (eds) Networks and Organizations: Structure, Form and Action, pp. 288–308. Cambridge, Massachusetts: Harvard Business School Press.

    Google Scholar 

  56. Parsons, T., 1960. Structure and Process in Modern Societies. Glencoe, IL: Free Press.

    Google Scholar 

  57. DSRU, 1998. Towards a common language. Background Paper 2. Devon: Darlington Social Research Unit.

    Google Scholar 

  58. Stern, L., 1996. Relationships, networks and the three cs. In D. Iacobucci (ed.) Networks in Marketing, pp. 3–7. Thousand Oaks, CA: Sage.

    Google Scholar 

  59. Hedberg, B., Dahlgren, G., Hansson, J., & Olve, N.G., 1997. Virtual Organizations and Beyond. New York: Wiley.

    Google Scholar 

  60. Coase, R.H. 1988. The Firm, the Market and the Law, Chicago, Ill: The University of Chicago Press.

    Google Scholar 

  61. Lawrence, P.F., & Lorsch, J.W., 1967. Differentiation and integration in complex organisations. Administrative Science Quarterly, 12, 1–47.

    Article  Google Scholar 

  62. Davis, M., 1983. Boundary and Space: An Introduction to the Work of D.W. Winnicott. Harmondsworth: Penguin.

    Google Scholar 

  63. Mathiesen, T., 1971. Across the Boundaries of Organizations. Berkeley, CA: The Glendessary Press, Inc.

    Google Scholar 

  64. Sarason, S., & Lorentz, E., 1998. Crossing Boundaries: Collaboration, Coordination and the Redefinition of Resources. San Francisco: Jossey-Bass.

    Google Scholar 

  65. Poxton, R., (ed.) 1999. Working Across the Boundaries: Experiences of Primary Health and Social Care Partnerships in Practice. London: King’s Fund.

    Google Scholar 

  66. Aldrich, H., & Reiss, A., Jr. 1971. Police officers as boundary personnel. In H. Hahn (ed.) Police in Urban Society, pp.193–208. Beverly Hills, CA: Sage.

    Google Scholar 

  67. Aldrich, H., & Herker, D., 1977. Boundary spanning roles and organization structure. Academy of Management Review, 77(2), 217–230.

    Google Scholar 

  68. Williams, P., 2001. Sieves not shells: Profiling boundary spanners. In: D. Purdue & M. Stewart (eds) Understanding Collaboration: International Perspectives on Theory, Method and Practice, pp. 75–82. Bristol: Faculty of the Built Environment, UWE.

    Google Scholar 

  69. Williams, P., 2002. The competent boundary spanner. Public Administration. 80(1), 103–124.

    Article  Google Scholar 

  70. Trist, E., 1985. Intervention strategies for interorganizational domains. In R. Tannenbaum, N Marguiles, F Massarik and associates. Human Systems Development: New Perspectives on People and Organizations, pp.167–197. San Francisco, CA: Jossey-Bass.

    Google Scholar 

  71. Lorenzoni, G., & Baden-Fuller, C., 1995. Creating a strategic center to manage a web of partners. California Management Review, 37(3), 146–163.

    Article  Google Scholar 

  72. Human, S., & Provan, K., 2000. Legitimacy building in the evolution of small-firms multilateral networks: A comparative study of success and demise. Administrative Science Quarterly, 45(2), 327–365.

    Article  Google Scholar 

  73. Emerick, R., Graham, D., & Kovanda, B., 1999. Multiskilling: Health Unit Coordination for the Health Care Provider. Albany, NY: Delmar Publishers.

    Google Scholar 

  74. March, J., & Simon, H. 1958. Organizations. New York: John Wiley.

    Google Scholar 

  75. Thompson, J., 1967. Organizations in Action. New York: McGraw-Hill.

    Google Scholar 

  76. Bolland, J.M., & Wilson, J.V., 1994. Three faces of integrative coordination: A model of interorganizational relations in community-based health and human services. Health Services Research, 29 (3), 341–357.

    PubMed  CAS  Google Scholar 

  77. Malone, T., & Crowston, K., 1994. The interdisciplinary study of coordination. ACM Computing Surveys, 26(1), March, 87–119.

    Article  Google Scholar 

  78. Stinchcombe, A.L., & Heimer, C.A., 1985. Organization Theory and Project Management. Oxford: Norwegian University Press.

    Google Scholar 

  79. Gould, N., (ed.) 2006. Multi Organisational Partnerships, Alliances and Networks, Engagement. Proceedings of the 12th MOPAN International Conference, 2005. Devon: Short Run Press.

    Google Scholar 

  80. Hamel, G., & Prahalad, C.K., 1994. Competing for the Future. Cambridge, Massachusetts: Harvard Business School Press.

    Google Scholar 

  81. Bradach, J., & Eccles, R., 1989. Price, authority, and trust: From ideal types to plural forms. Annual Review of Sociology, 15, 97–118.

    Article  Google Scholar 

  82. Warner, M., 1997. Re-designing Health Services: Reducing the Zone of Delusion. London: Nuffield Trust.

    Google Scholar 

  83. Warner, M.M., 1999. Virtual reorganisation by design: An approach to progressing the public’s health in Wales using networks In WHO 4th European Consultation on Future Trends: The Health 21 Framework, London, 14th December.

    Google Scholar 

  84. Warner, M.M., 2002. A European view In M. Marinker (ed.) Health Targets in Europe: Polity, Progress and Promise, pp.165–180. London: BMJ Books.

    Google Scholar 

  85. Warner, M., & Gould, N., 2003. Integrated care networks and quality of life: Linking theory and practice. International Journal of Integrated Care. 3 October 9th Edition 2003, ISSN 1586

    Google Scholar 

  86. Warner, M., & Gould, N., 2003. Community health alliances through integrated networks (CHAIN): Reporting project progress in South Wales with reference to the UK National Service Framework for Older People. In M. Garcia-Barbela, D. Groen (eds.) International Conference on New Research and Developments in Integrated Care. Barcelona: IJIC, 21–22 February.

    Google Scholar 

  87. Warner, M., & Gould, N., 2004. Virtual co-ordination: Re-framing systems’ management In Integrated Care Conference. Birmingham: IJIC, 20–21 February.

    Google Scholar 

  88. Van Gennep, A., 1960. The Rites of Passage. London: Routledge & Kegan Paul.

    Google Scholar 

  89. Turner, V., & Turner, E., 1978. Image and Pilgrimage in Christian Culture – Anthropological Perspectives. Oxford: Basil Blackwell.

    Google Scholar 

  90. Gould, R., & Fernandez, R., 1989. Structures of mediation: A formal approach to brokerage in transaction networks. Sociological Methodology, 19, 89–126.

    Article  Google Scholar 

  91. Fernandez, R., & Gould, R., 1994. A dilemma of state power: Brokerage and influence in the national health policy domain. American Journal of Sociology, 99(6), May, 1455–1491.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Welsh Institute for Health and Social Care, Glyntaff Campus, University of Glamorgan, Pontypridd, Wales

    Morton Warner

Authors
  1. Morton Warner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nicholas Gould
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Morton Warner .

Editor information

Ilona Kickbusch

Rights and permissions

Reprints and permissions

Copyright information

© 2009 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Warner, M., Gould, N. (2009). Integrating Health in All Policies at the Local Level: Using Network Governance to Create ‘Virtual Reorganization by Design’. In: Kickbusch, I. (eds) Policy Innovation for Health. Springer, New York, NY. https://doi.org/10.1007/978-0-387-79876-9_5

Download citation

  • DOI: https://doi.org/10.1007/978-0-387-79876-9_5

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-79875-2

  • Online ISBN: 978-0-387-79876-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation