Abstract
Expectations of healthcare networks are high: they provide easier information sharing, sharing of resources and risks and achieving economies of scale. However, networks do not always reach their goals. A possible cause is, that not all network members are (equally) committed towards the network goals. If partners put in different amounts of effort in achieving the common goal, or when partners are more concerned about achieving their own organization’s goals, this may result in disillusionment or disappointment in what the network can achieve, and ultimately in disengagement of its members.
In a local primary care network in the Netherlands, we investigate how involvement affects network members’ perceptions of network goal attainment, mediated by social comparison and organizational goal attainment. The network consists of 30 practices (the ‘partners’): general practitioners (GP’s), physical therapists, psychologists, a pharmacy, children’s specialists, a dietician, speech therapists and practice therapists. Almost half of the practices are located within the same physical building, while the other half is located in other parts of the town. Collaboration takes place in ‘health programs’, financed by health insurance and by patients enrolled in the program. The research contained a mixed-methods approach with surveys, interviews and desk research.
We find, first, that the network is strongly shaped by the building that houses part of the network. Partners located within the building form the core of the network, show higher network involvement and think their input is higher than that of others. Next, perceived network goal attainment is lower when partners assess the commitment of others as lower than their own commitment. Interviews with organizational representatives confirm this finding; but they also stress the specific role of the GP’s, who could be more involved in developing and improving the network’s health programs, while currently they mainly refer patients to the health programs. When partners interpret the GP’s role differently – they expect more instrumental commitment – they become dissatisfied. Respondents also mention the specific role of physical therapists, who are subject to different national payment regulations and competition within the network. This indicates that the specific function of the partner is an important variable that explains why members are (dis)satisfied with the performance of the network. Last, partners that indicate they achieve organizational goals by network membership, are less positive about network goal attainment. This effect is larger for partners located within the building than outside. However, according to partners, this does not necessarily impede network goal attainment. Summarizing, even though social comparison and organizational goal attainment play a role between commitment and perceived network goal attainment, the partner’s position and specific role and function are important to take into account when evaluating the performance of a network and implementing change.