Context Since 2010 Belgium launched a reform programme ‘towards a better mental health through the realization of care circuits and care networks’ promoting an integrated and community-based care model. Within this programme, 19 regionally distributed interorganizational mental health networks (MHN) were set up as pilots. The implementation experiences show us that working in networks requires a particular understanding of the context and urges to set up adequate network governance structures in order to improve network effectiveness (Provan & Kenis, 2007). Methods Our research is inspired by a realist evaluation approach (Pawson & Tilley, 2004; Pawson, 2013). This methodology recognises the complexity of interventions and urges to recognize context and the dynamic relationships between various actors. We aim to understand the MHN implementation and its governance. We use a prospective approach. Data collection and analysis include a documentary analysis of the 19 network plans, semi-structured face-to-face interviews with the network coordinators and promotors and focus group interviews with the MHN core partner organizations. We focus on the perceptions of the stakeholders regarding network governance (both strategic and operational) and on the implementation experiences, more specifically the facilitating and hampering factors related to the governance of the MHN. Results The MHN use different governance approaches in this newly emerging complex (Belgian) field. Governing is mainly a 'learning by doing' experience: network partners seldom jointly reflect on the objectives and strategy of the MHN or on the governance model. Most governing bodies are developed ad hoc rather than based on a clear and common vision on a sustainable network. Partner organizations indicate that a lot of time is spent to get to know each other. The degree of mutual trust, often related to previous collaboration, affects strategic thinking and governance. Communication between governing bodies (horizontal) and towards the operational level (vertical) is often perceived as problematic. In cases where networks changed the initial governance model it is mainly a movement from a more participative towards a more layered or centralised governance model. Discussion Research on network governance in this type of public health domain is scarce. However findings from governance and management literature are useful to understand the dynamics of this reform movement (e.g. Provan & Kenis, 2007). Governing a network with multiple partner organisations from different policy sectors encounters various difficulties. The ‘field' or ‘domain' characteristics and some intrinsic aspects of the reform programme raise particular problems in developing adequate network governance. Particularly for the mental healthcare sector it is not so much the "collaboration" between partners, but rather the development of adequate and well managed networks: historically collaborative experiences have mainly developed on the clinical and inter-professional level, far less on the institutional level. Moreover the complexity of the Belgian policy structures raises particular challenges. In the next stage of the process evaluation we will examine more closely what types of governance models are more adapted to context and network characteristics.
|Title of host publication||EHMA Annual Conference|
|Subtitle of host publication||Evidence-based management: better decisions, better healthcare|
|Publication status||Published - 17 Jun 2015|
|Event||EHMA Annual Conference - Breda, Netherlands|
Duration: 15 Jun 2015 → 17 Jun 2015
|Conference||EHMA Annual Conference|
|Period||15/06/15 → 17/06/15|