Building Health Communities: Local Health Care Networks in Maryland

• Author: Aaron Wachhaus
• Published date: 01 January 2020
• Date: 01 January 2020
• DOI: http://doi.org/10.1177/0275074019864298
• Subject Matter: Articles

https://doi.org/10.1177/0275074019864298

American Review of Public Administration

2020, Vol. 50(1) 62 –76

© The Author(s) 2019

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DOI: 10.1177/0275074019864298

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Article

Networks and networking principles play an increasingly

important role in governance. As is the case with many pub-

lic services, networks are being promoted as a means of

effectively delivering public health. In this paradigm, local

health departments play a coordinating role, acting as bro-

kers and bridges between intersectoral networks of collab-

orative partners (Institute of Medicine [IoM], 2012; National

Association of County & City Health Officials [NACCHO],

2016, 2017). A body of work examining local health care

networks is beginning to develop (e.g., Harris, Leider,

Carothers, Castrucci, & Hearne, 2016; Hogg & Varda, 2016;

McCullough, Eisen-Cohen, & Salas, 2016). This study adds

to that scholarship by mapping and examining five local

health care networks in Maryland. Using the distinction

between serendipitous and goal-directed networks (Kilduff

& Tsai, 2003), this study more closely examines health care

networks and is able to make network management recom-

mendations based on the type of network identified. The

article begins with an overview of network and network

management literature and reviews serendipitous and goal-

directed networks. A shift toward collaboration and network-

ing in health care follows, along with a case description.

Methods and results of the study are presented and discussed;

the article concludes with a call for additional lines of

research and highlights the necessity of developing mecha-

nisms to support network management in practice.

Networks, an Overview

It has been nearly 20 years since a “transformation of gover-

nance” was described (Kettl, 2000). That transformation

was based largely on the increase of boundary-spanning

connections, decentralization, devolution, and a reliance on

street-level actors to deliver services. In other words, gover-

nance was adopting network principles and practices.

Networks have long been framed as a third form of gover-

nance, alongside market-based and hierarchical approaches

(Considine & Lewis, 1999; Miller, 1994; Powell, 1990). As

Keast, Mandell, and Brown (2006) note, these three “pri-

mary modes of social organization . . . represent ways of

organizing society” (p. 27). The growth of network gover-

nance has given rise to concerns about the hollowing of the

state (Milward & Provan, 2000; Rhodes, 1997) and the

impact that decentralization, a flat organizational structure,

and dispersed accountability will have on traditional struc-

tures of government.

Networks and networking, however, appear to be here to

stay, as they offer distinct benefits. Fundamentally, networks

accommodate resource scarcities, as they proceed from con-

ditions of interdependence and facilitate strategies to opti-

mize shared resources (Keast, Mandell, Brown, & Woolcock,

2004; Klijn, 2001). Networks are “structures of interdepen-

dence” (O’Toole, 1997, p. 45); the justification for forming a

connection with another person or organization is that a go-

alone strategy is not possible (Agranoff & McGuire, 2001a;

Imperial, 2005). Networks form as actors realize that the

only way to achieve their goals is through collaborative

action and resource sharing (Agranoff & McGuire, 1998).

864298ARPXXX10.1177/0275074019864298The American Review of Public AdministrationWachhaus

research-article2019

1University of Baltimore, MD, USA

Corresponding Author:

Aaron Wachhaus, University of Baltimore, 1420 N Charles St., Baltimore,

MD 21201, USA.

Email: awachhaus@ubalt.edu

Building Health Communities: Local

Health Care Networks in Maryland

Aaron Wachhaus1

Abstract

Combatting chronic disease (prevention and treatment of obesity, diabetes, heart health, and stroke) requires action at

the local level, both to educate the public and to provide health services. Effective collaboration among local organizations

devoted to educating the public about, and treating patients of, these diseases is a key component of successful health care.

To better understand local efforts, a social network analysis of five local health care networks spanning eight counties in

Maryland was conducted. The purpose of this exploratory research was to discover whether collaborative networks exist at

the local level, to map the networks, and to assess their strengths and needs.

Keywords

collaboration, healthcare, networks