This is a review of the study carried out by The Health Foundation (THF) which launched its programme to support healthcare networks  in October 2011

Networks are defined as cooperative structures where an interconnected group, or system, coalesce around shared purpose, and where members act as peers on the basis of reciprocity and exchange, based on trust, respect and mutuality. Networks can be set up for a variety of purposes: to promote a policy agenda, to support collective learning, to advocate for change or to actually change practice:

• interconnected groups or  systems focusing on a shared purpose
• the huge potential that networks have to  address complex challenges is increasingly accepted in political, business and social spheres
• a network can be a powerful way of sharing  learning and ideas, building a sense of community and purpose, shaping new solutions to entrenched problems, tapping into hidden talent and knowledge, and providing space to innovate and embed change

In 2010, Helen Bradburn, the then Director  of Communications for the Health Foundation, began to seriously explore the  organisation’s potential to extend its work  with networks. She says: ‘We are interested in how change happens at scale. We knew  from our own experience how networks had been used to sustain collaboration during  times of upheaval, or to build support for  improvements to quality. We wanted to  explore what role we could play in supporting  networks to be more  successful, make  connections and learn from each other, and  how we could engage more people in our  work in the process.’

Factors leading to growth of networking activities in UK

• redefined organisational boundaries in the health services- e.g. safeguarding issues
• a need for increasing interdependence  between healthcare organisations in order to provide services that are more personalised-personalised agenda
• networks emerging as a potentially more  effective way of working on intractable complex issues that have not been solved through traditional organisational models
• the huge growth in the use of professional and social networking tools, with social networks often providing invaluable support in times of change
• networks being noticed, and therefore becoming more visible

Challenges identified:

• leadership that tend to make the potential membership feeling isolated.
• economic crises- where margins are very squeezed, Individual members prefers to concentrate in their own internal improvements of their business if they have to survive.
• funding-This is more a problem where the group is dormant or not visible- who would fund a non operational organisation
• geographical coverage-lines of communication (verbal and non-verbal)

Outcome of the study

Study establiblished that there is a diversity in scope and level of development in various networks-Pre-emergent (planning stage),Emerging (set up but has no clear strategy),Established ( has a clear strategy, form and functions) and Dormant ( still exists but has failed to achieve purpose of its formation).

Networks are effective/ works where there is consensus rather than top-down directive structure. This means that members  are involved in setting up workshops and events.

Training small groups of staff to run rapid improvement workshops has a real multiplier effect. The study found out that within nine months, potentially hundreds of people in one organisation can be reached.

Tips for network leaders

• Face-to-face meetings and events are essential, but don’t overload people.
• keep your meetings fresh and varied so they keep coming back.

Borrow ideas from others. Other networks have gone through the same route e.g. the flipchart route whereby delegates draw up a flipchart outlining a problem they’d like help with. Then everyone circulates around the room for 45 minutes, discussing them and including their own comments. This worked well to get people talking and exchanging contact details.

• Ask for freebies, share resources and piggyback in other events. You’ll be surprised at what you can achieve for little outlay, or even for free.
• Don’t worry if overall consensus feels unachievable. There’s usually some action that everyone agrees on.
• Simply trying something – however small – can help to move you in a positive direction.

Start with the enthusiasts, and work with people who already have strong informal networks that you can  plug into. “We set up a steering group early on, which ensured representation from a good cross-section of  these people”.

Spread your net wide in recruiting members. Diversity in membership can become one of your biggest assets. eg have active involvement from patients, carers and a number of patient groups. They bring an important perspective, and this creates  a unique space for patients and clinicians to discuss  these issues together.

Use a thematic approach to bring in new members, reflecting the priorities that have emerged from the  community. “There is a core group of people who come regularly to our meetings, but the use of themes has  helped us widen out. eg, we have been able to recruit more pharmacists as a result of a recent focus  on medicines management”.

In all your activities, always identify a product or a take-home message or action. Nobody wants to waste time. Everybody likes challenges.

If you’re passionate about your subject, give it a go. There are many different leadership styles for achieving a strong network, but it’s the passion that counts most.

“Don’t underestimate the importance of a central skilled resource to support the network. Early on, we were able to identify funding to appoint a coordinator. It’s a critical role: someone dedicated to organising and running our  meetings and keeping good records”

Measuring the Success of a network:

• their ability to be innovative and creative, and their reliance on diversity
• the distribution of power and leadership across members
• reciprocity and exchange as the defining relationship between members, based on mutual interest around a common purpose
• fluctuations in member engagement and impact
• their adaptability to survive and thrive
• their focus on generating and sharing  knowledge

As networks are primarily innovative, creative places, they are useful for rapid learning and development, and for amplifying members’ effectiveness. Networks can also be useful for advocacy on behalf of their members, and for delivering services in ways that make the most of network members’ capability and resource

Therefore, the PRIMARY functions of a network are:

Community building –  individuals or groups.

Filtering – members.

Amplifying – ideas and make them public, give them weight, or make them understandable.

Facilitating – the network functions to help members carry out their activities more efficiently and effectively.

Investing or providing – the network functions to provide members with the resources they need to carry out their main activities.

Convening – of people with distinct strategies to support them.

Failure of a network

• A failure to reach a sufficiently common understanding across members of purpose and direction.
• Institutionalisation, with a tendency to excessively control and to manage out diversity rather than working with it.
• Over-management, with networks getting bogged down in the governance arrangements and bureaucracy they were originally set up to overcome. This is often caused by cementing relationships and structures that should have remained dynamic and evolving.
• Lack of attention to initial design and/or failure to design for evolution.
• Unrealistically high expectations of network members’ willingness or ability to collaborate, which damages creativity, and a failure to regularly discuss, share and test expectations among members.
• The tendency to prioritise some network members’ interests over others.
• Actions that constrain network members’ independence – especially their need to interpret or express the work of the network differently at a local level.
• A lack of recognition when leadership needs to change or rotate.
• Insufficient impact in terms of fulfilling the purpose of the network members-becomes dormant.
• Failure to recognise the breadth and depth of different kinds of knowledge from within the network

Opportunities:

Opportunity is when you can meet needs and not just wants. This means that an effective Network is which try to see through the needs of individual members-Training, providing care or simply advisory services, advocacy (representation) etc.

Conclusion:

There are other documented (just Google!) findings that social networks improve individual, team and organisational performance in healthcare – particularly where they lead to more information sharing, and where they are inclusive of diverse groups of people.