Abstract
Background: Purpose-oriented networks (1) are networks in which organisations arrange care together around a specific group of patients/clients/citizens to provide integrated care. This reflects the urgency to better align and organise care and support around people’s needs (2). Four criteria are important: A) degree of shared purpose, B) degree of membership of three or more actors, C) degree of joint effort for the determined mutual objectives, and D) governance aligned with cross-organisational collaboration (1).
In the implementation of purpose-oriented networks, aligned accountability is yet underdeveloped. Accountability that needs to be delivered now is primarily organisational oriented (3) and includes both supervision (demanding accountability) and responsibility (delivering accountability)(4). A study about perspectives of Dutch national healthcare stakeholders of accountability in purpose-oriented networks was conducted.
Approach: Representatives of national Dutch healthcare stakeholders participated in this study concerning Healthcare and Youth Inspectorate, Healthcare Authority, Healthcare Institute, Healthcare Insurance Company, Healthcare Insurers Association, Municipalities, Association of Netherlands Municipalities, Supervision Social Domain, Association of supervisors in healthcare, Accountancy firms, Patient Federation Netherlands.
Questions concerned conceptual definitions of accountability, accountability mechanisms, accountability to supervisors, accountability that focuses on the perspective of society, citizens/clients/patients, accountability systems and accountability style (5).
Results:
All stakeholders interviewed consider the topic of accountability in purpose-oriented networks delivering integrated care to be of the utmost importance. These are:
•Interrelationships within networks and the context of the network
•Accountability to be shaped by the network itself or by others
•The role of supervisory boards of the individual participating organizations in inter-organisational networks
•Standards and rules from a supervisory perspective
•The role of mandate and representation from the network
•Accountability meets public values: quality care, affordability and accessibility.
•All participants involved in purpose-oriented networks need to be included in the accountability process, from the beginning, through the process and in the follow-up.
Implications: These themes, the ways of thinking and perspectives, provide a basis for further development of accountability in purpose-oriented networks. Overarching themes are the development of clear common goals, transparency, trust, resilience, adaptability and societal objectives. These implications can add to an effective integrated care governance and can add by providing a direction of organizing accountability on the scale of networks in the region.
1.Nowell B, Kenis P. Purpose-Oriented Networks: The Architecture of Complexity. Perspect Public Manag Gov. 2019 Sep 1;2(3):169–73.
2.Minkman M. Suitable scales; rethinking scale for innovative integrated care governance. Int J Integr Care. 2020;20(1):1–5.
3.Van Kerkvoorden DR, Ettema RGA, Minkman MMN. Accountability in healthcare in the Netherlands: A scoping review. Int J Health Plann Manage [Internet]. 2024 Apr [cited 2024 Jan 14];39(2):237–61. Available from: https://onlinelibrary.wiley.com/doi/10.1002/hpm.3743
4.Van Montfort C. Beschouwing over toezicht, accountability en rekenschap. 2024 [cited 2024 Oct 30]. Project EISON. Available from: https://www.tilburguniversity.edu/nl/onderzoek/instituten-en-researchgroepen/eison/beschouwingen-over-toezicht-accountability-en-rekenschap
5.Alvarez-Rosete A. An empirical investigation of accountability arrangements in 4 leading international integrated care systems [ Chapter Handbook Integrated Care, to be published]. In 2025.