Outcomes of Interorganizational Networks in Canada for Chronic Disease Prevention: Insights From a Concept Mapping Study, 2015.

INTRODUCTION: We conducted a mixed methods study from June 2014 to March 2015 to assess the perspectives of stakeholders in networks that adopt a population approach for chronic disease prevention (CDP). The purpose of the study was to identify important and feasible outcome measures for monitoring network performance. METHODS: Participants from CDP networks in Canada completed an online concept mapping exercise, which was followed by interviews with network stakeholders to further understand the findings. RESULTS: Nine concepts were considered important outcomes of CDP networks: enhanced learning, improved use of resources, enhanced or increased relationships, improved collaborative action, network cohesion, improved system outcomes, improved population health outcomes, improved practice and policy planning, and improved intersectoral engagement. Three themes emerged from participant interviews related to measurement of the identified concepts: the methodological difficulties in measuring network outcomes, the dynamic nature of network evolution and function and implications for outcome assessment, and the challenge of measuring multisectoral engagement in CDP networks. CONCLUSION: Results from this study provide initial insights into concepts that can be used to describe the outcomes of networks for CDP and may offer foundations for strengthening network outcome-monitoring strategies and methodologies.

Be careful what you ask for: Things policy-makers should know before mandating networks.

Agents of government have increasingly used networks as policy tools to connect organizations within and/or across public sector jurisdictions. This has been particularly striking in health systems across Canada. Cynics argue they are pseudo-fixes; we take a more optimistic view. We explore the unique features of mandated networks, sharing their limitations and possibilities and providing targeted messages for policy-makers considering using them, ultimately suggesting that they should "be careful what they ask for."

Advancing family-centred care in child and adolescent mental health: a critical review of the literature.

Family-centred care (FCC) is a key factor in increasing health and related system responsiveness to the needs of children and families; unfortunately, it is an unfamiliar service model in children's mental health. This critical review of the literature addresses three key questions: What are the concepts, characteristics and principles of FCC in the context of delivering mental health services to children? What are the enablers, barriers and demonstrated benefits to using a family-centred approach to care in children's mental health? And how can we facilitate moving an FCC model forward in children's mental health? A range of databases was searched for the years 2000­2011, for children ages zero to 18 years. Articles were selected for inclusion if a family-centred approach to care was articulated and the context was the intervention and treatment side of the mental healthcare system. This literature review uncovered a multiplicity of terms and concepts, all closely related to FCC. Two of the most frequently used terms in children's mental health are family centred and family focused, which have important differences, particularly in regard to how the family is viewed. Initial benefits to FCC include improved child and family management skills and function, an increased stability of living situation, improved cost-effectiveness, increased consumer and family satisfaction and improved child and family health and well-being. Significant challenges exist in evaluating FCC because of varying interpretations of its core concepts and applications. Nonetheless, a shared understanding of FCC in a children's mental health context seems possible, and examples can be found of best practices, enablers and strategies, including opportunities for innovative policy change to overcome barriers.

Positively deviant networks: what are they and why do we need them?

PURPOSE: This paper aims to report "positively deviant" experiences of three public sector networks seeking to enhance organizational and system level capacities. It is the authors' thesis that the knowledge base concerning the true benefits and pitfalls of networks can be captured and interpreted only through intense, ongoing learning effort embedded in practice on the ground, combined with sustained in-depth observation and collaborative research. DESIGN/METHODOLOGY/APPROACH: The paper describes through case examples why and how different kinds of networks within different jurisdictional contexts and different organizational cultures are being used to enhance the climate for change towards better health care and improved health. The authors describe the contexts, structures, processes and impacts of three "positively deviant" networks. FINDINGS: The network form can provide opportunity for nurturing changes and innovations within large organizational and complex system environments. This opportunity to create additional and different pathways for improved decision making and service provision comes with challenges that should be recognized. PRACTICAL IMPLICATIONS: The authors' experiences indicate that, for networks, a key component of success relates to pulling and pushing at the edges of multiple connections and boundaries in "positively deviant" ways. This pushing and pulling is intrinsically evidence of organizational and intraorganizational learning--in the examples presented--for the improvement of health care and health. ORIGINALITY/VALUE: Other networks can learn from the reported experiences and add their own cases to the empirical understanding of how networks can make a difference; this in turn can help the conceptual and theoretical understanding of them.

Re-examining the paradox of structure: a child health network perspective.

In their lead paper, Huerta, Casebeer and VanderPlaat argue that there are several key forces driving the development of health services delivery (HSD) networks, and propose a series of paradoxes and propositions to initiate this timely and essential dialogue. Ultimately, they submit that networks are likely to remain within the healthcare system to build system capacity and drive integration. Given this, they challenge us to further the dialogue and investigate these networks. While this peer commentary shares many of the lead author's perspectives, the generic nature of the discussion does not bring us to the relative complexities revealed in some HSD network practices. A Canadian child health network lens is used to re-examine the lead paper's conceptualization of network typologies and the proposed paradox of structure. We combine network practice and academic expertise to highlight the structural, governance and leadership tensions between traditional hierarchical public service organizations and the non-hierarchical nature of inter-organizational networks. Child health network leaders and members must examine and work with the challenges associated with importing traditional organizational cultures into an inter-organizationally networked context, while simultaneously maintaining these dual (or duelling) cultures.

Creating frameworks for providing services closer to home in the context of a network.

Networks can be used to develop shared frameworks that extend limited specialized healthcare services beyond tertiary level settings to provide services closer to home. This article provides an overview of networks, describes the context and purpose of the Southern Alberta Child & Youth Health Network, reports on early experiences with implementation of an Outreach Services Framework, and discusses implications from a network perspective.