Figure 1
PRISMA flow of article selection process.
Table 1
Summary of included articles on decision-making in integrated care service networks.
| AUTHORS | REFERENCE NUMBER | COUNTRY AND SECTOR | METHODS | NETWORK STAKEHOLDERS | NETWORK SIZE | GOVERNANCE MODEL | FAVOURED DECISION-MAKING WAY: INCLUSIVE OR EFFICIENT? | ELEMENTS OF DECISION-MAKING DILEMMAS |
|---|---|---|---|---|---|---|---|---|
| Ales et al. (2011) | 24 | United States of America, Health care | Survey and interviews | Collaboration between university departments (n = 3) and (medical) education organisations (n = 6) | 9 organisations | Participant-governed | Inclusiveness in terms of key decisions (mission, governance, financial deviations from budget), otherwise efficiency | 1. Loss of autonomy vs. shared commitment 2. Finding appropriate group size 3. Flexibility vs. structure |
| Alexander et al. (2010) | 25 | United States of America, Health care | Multiple case study (interviews) | 4 different networks consisting of health care providers, purchasers and clients | Unspecified | 2 participant-governed and 2 lead-organisation | Described dilemma of inclusiveness (consensus based) vs. efficiency (exclusive, smaller decision-making groups) | 1. Competing agendas stakeholders 2. Negative historical relationships 3. Balancing long-term goals versus specific goals 4. Culture differences (diversity) |
| Alidina et al. (2016) | 26 | United States of America, Social care | Survey and interviews | Network of patient-centred medical homes with physicians, managers, staff | 13 organisations | Participant-governed | Unspecified | 1. Decision-making costs 2. Time needed to build relationships 3. Communication barriers |
| Anwari et al. (2015) | 27 | Afghanistan, Health care | Case study (survey, system data, focus group discussions) | Provincial public health coordination committee including 21 members | 10 organisations | Participant-governed | Efficiency (several subcommittees were established for e.g. decision-making. Information was shared top-down) | 1. Lack of commitment to the network and decisions 2. No transparent decision-making |
| Barnett et al. (2009) | 28 | New Zealand, Health care | Survey and interviews | 21 different district health boards. Chairs appointed by Minister of Health | 11 members per board | Lead-organisation governed | Inclusiveness (striving for non-mandated horizontal relationships) | 1. Unclear roles 2. Power imbalances 3. Dual accountabilities |
| Carstens et al. (2009) | 29 | United States of America, Social care | Survey and interviews | 13 networks with organisations in child protection services, mental health, drug and alcohol, human services | 29 organisations | Participant-governed | Inclusiveness in the design (18 types of stakeholders were involved in decisions), but for efficiency purposes families were brought (too) late to the table | 1. Competing agendas stakeholders 2. Knowledge differences 3. Lack of cooperation 4. Autonomous stances 5. Silo thinking |
| Checkland et al. (2013) | 30 | England, Health care | Multiple case study (surveys, observations, interviews) | 8 clinical commissioning groups (GPs, lay members, managers, nurses, local authority, others) | Unspecified | Lead-organisation governed | Efficiency (most groups chose to split up in subcommittees for efficiency purposes) | 1. Unclear external accountability to NHS boards constrain rapid decisions 2. Smaller groups for efficiency vs. opened membership for inclusion |
| De Regge et al. (2018) | 31 | Belgium, Health care | Focus group discussions | Hospital stakeholders network with physicians, administrators and clients | Unspecified | Participant-governed | Inclusiveness (decisions must consider each point of view and include all voices) | 1. Competing agendas: organisation vs network 2. Differences in perceptions |
| Gale et al. (2017) | 32 | England, Health care | Interviews | Health research network (nurses, pharmacists, health trainers, clients) | Unspecified | Participant-governed | Inclusiveness (respecting and including cultural wisdom of all parties involved) | 1. Lack of trust and relationships 2. Set rules and procedures vs. adaptability 3. Recognising peoples’ expertise |
| Harris et al. (2017) | 33 | Australia, Health care | Case study (interviews, workshops, document analysis) | Network of 6 hospitals, rehabilitations services, mental health and community health services and residential aged care services. | 22 committees, 9 approved purchasing units, 1 steering committee, 6 hospitals and a number of unspecified other organisations | Participant-governed | Inclusiveness within committees (deliberative processes), and efficiency due to establishing ‘higher-level’ and ‘lower-level’ committees | 1. No formal decision-making process 2. Lack of evidence for decisions 3. Lack of coordination, communication, collaboration 4. Not wanting to include outsiders |
| Hearld et al. (2012) | 34 | United States, Health care | Quantitative surveys | 14 health care alliances (insurer companies, employers, care providers, government organisations, consumer organisations, others) | 1191 members from various organisations (570 filled in the survey) | Participant-governed | Inclusiveness (open and inclusive alliance decision-making processes) | 1. Information asymmetry 2. Not devoting enough time to network activities |
| Hoey, Pelletier (2011) | 35 | Central America, Health care | Interviews | Network of Ministry of Health, United Nations, NGOs | 3 Ministry of Health actors, 1 United Nations member, 4 NGO actors | Lead-organisation governed | Efficiency (perspectives of NGO-employees are not considered by the MoH when taking decisions) | 1. Conflicting views 2. Power imbalances 3. Not wanting to include outsiders 4. Mistrust |
| Marshall et al. (2021) | 36 | England, Health and social care | Interviews | Staff and managers from different care homes, GPs, social workers, hospices, local authorities (bottom-up networks created during COVID-19) | Unspecified | Participant-governed | Efficiency (due to rapid decisions needed during COVID-19) | 1. Autonomy vs. interdependence 2. Self-interest vs. common goals 3. Different interpretations of decisions |
| Montenegro & Mercado (2019) | 37 | Chile, (Mental) health care | Interviews and participant observations | Local community mental health service network including service users/community members and mental health professionals | Unspecified | Network-administrative governed | Inclusiveness (the network has to be big because big decisions are made, it needs to be representable) | 1. Diversity vs. coherence 2. Self-interest vs. common goals 3. Representation vs. mandate 4. Inclusiveness vs. efficiency |
| Ramgard, Forsgren, Avery (2017) | 38 | Sweden, Health and social care | Dialogue, reflections, research circles, workshops, focus group discussions | Voluntary network representing 33 municipalities | >50 members | Participant-governed | Efficiency (decisions were mainly top-down made by politicians) | 1. Competing agendas organisations vs. network 2. Power imbalances |
| Santos, Giovanella. (2014) | 39 | Brazil, Health care | Case study (interviews, focus group discussions, observations, document analysis) | Regionalised network representing 19 municipalities (state secretary of health, administrators, managers, health professionals) | Unspecified | Lead-organisation governed | Efficiency (politicians formulated the agendas leaving insufficient space for dialogue between stakeholders) | 1. Power imbalances 2. No problem-solving strategies 3. Lack of autonomy |
| Valaitis et al. (2018) | 40 | Canada, Health care | Interviews | Primary care and public health collaboration (health care professionals, managers, policy makers, researchers, consultants, coordinators, health educators) | >70 members | Participant-governed | Inclusiveness (striving for shared decision-making across disciplines) | 1. Unclear roles 2. Culture differences (diversity) 3. Lack of common language |
| Walker, Smith, Adam (2009) | 41 | Australia, Health and social care | Interviews | Primary care partnership committees (CEOs, managers, care service providers) | 31 committees | Participant-governed | Inclusiveness (transcend differences and find common ground to achieve shared goals) | 1. Breaches of trust 2. Competing agendas organisations vs. network |
Figure 2
Illustrated decision-making dilemmas within integrated care service networks.