Unravelling collaborative governance dynamics within healthcare networks: a scoping review.

In many countries, healthcare systems suffer from fragmentation between hospitals and primary care. In response, many governments institutionalised healthcare networks (HN) to facilitate integration and efficient healthcare delivery. Despite potential benefits, the implementation of HN is often challenged by inefficient collaborative dynamics that result in delayed decision-making, lack of strategic alignment and lack of reciprocal trust between network members. Yet, limited attention has been paid to the collective dynamics, challenges, and enablers for effective inter-organisational collaborations. To consider these issues, we carried out a scoping review to identify the underlying processes for effective inter-organisational collaboration and the contextual conditions within which these processes are triggered. Following appropriate methodological guidance for scoping reviews (Arksey and O Malley, 2005), we searched four databases (PubMed (n=114), Web of Science (n=171), Google Scholar (n=153), and Scopus (n=52) and snowballing (n=22)). Thirty-seven papers addressing HN including hospitals were included. We used a framework synthesis informed by the (Emerson, 2011) collaborative governance framework to guide data extraction and analysis, while being sensitive to emergent themes. Our review showed the prominence of balancing between top-down and bottom-up decision-making (e.g., strategic versus steering committees), formal procedural arrangements, and strategic governing bodies in stimulating participative decision-making, collaboration, and sense of ownership. In a highly institutionalised context, the inter-organisational partnership is facilitated by pre-existing legal frameworks. HN are suitable for tackling wicked healthcare issues by mutualising resources, staff pooling and improved coordination. Overall performance depends on the capacity of partners for joint action, principled engagement and a closeness culture, trust relationships, shared commitment, distributed leadership, power sharing and interoperability of information systems. To promote effectiveness of HN, more bottom-up participative decision-making, formalisation of governance arrangement and building trust relationships are needed. Yet, there is still inconsistent evidence on the effectiveness of HN in improving health outcomes and quality of care.