Knowledge Sharing in a Third‐Party‐Governed Health and Human Services Network

• Author: Kun Huang
• Published date: 01 September 2014
• Date: 01 September 2014
• DOI: http://doi.org/10.1111/puar.12222

Kun Huang is associate professor in

the School of Public Administration and

senior fellow in the Robert Wood Johnson

Foundation Center for Health Policy

University of New Mexico. His research

interests focus on the use of organization

theory and network analysis to study

interorganizational and network relation-

ships, including network strategy, structure,

evolution, and governance.

E-mail: khuang@unm.edu

Knowledge Sharing in a Third-Party-Governed Health and Human Services Network 587

Public Administration Review,

Vol. 74, Iss. 5, pp. 587–598. © 2014 by

The American Society for Public Administration.

DOI: 10.1111/puar.12222.

Kun Huang

University of New Mexico

 e rapid growth of knowledge in disease diagnosis and

treatment requires health service provider organiza-

tions to continuously learn and update their practices.

However, little is known about knowledge sharing in

service implementation networks governed by a network

administrative organization (NAO).  e author suggests

that strong ties enhance knowledge sharing and that there

is a contingent ef‌f ect of third-party ties. Two provider

agencies’ common ties with the NAO may under mine

knowledge sharing because of resource competition. In

contrast, a dyad’s common ties with a peer agency may

boost knowledge sharing as a result of social cohesion.

Finally, the author posits that third-party ties moder-

ate the relationship between strong ties and knowledge

sharing.  ese hypotheses are examined in a mental

health network. Quantitative network analysis conf‌i rms

the strong tie and third-party tie hypotheses and provides

partial support for the moderating ef‌f ect of third-party

ties.  e implications for public management, including

the implementation of HealthCare.gov, are discussed.

State and local government agencies increasingly

contract with for-prof‌i t and nonprof‌i t entities

for the delivery of taxpayer-funded health and

human services (Salamon 2002). A service imple-

mentation network is created when a lead contractor

assembles, through subcontracting or fee-for-service

arrangement, a set of public, nonprof‌i t, and/or for-

prof‌i t service providers to jointly produce a service

such as community trauma care or drug or alcohol

prevention (Chen 2010; Desai and Snavely 2012;

Provan and Milward 2001).

Such complex network arrangements have received

considerable attention from public administration

scholars. Most of the public administration literature

has focused on the challenges of managing the princi-

pal–agent relationship between

government and contractors

(Bloomf‌i eld 2006; Brown,

Potoski, and Van Slyke 2010;

Carboni and Milward 2012).

However, an understudied

area in service implementation networks is inter-

provider knowledge sharing, or the degree to which

two exchange partners disclose information that may

facilitate the other party’s activities (McEvily and

Marcus 2005).

 e recent HealthCare.gov f‌i asco illustrates the

importance of knowledge sharing.  e online federal

health insurance exchange relied on a primary con-

tractor and 50 subcontractors for service implemen-

tation and integration.  e Patient Protection and

Af‌f ordable Care Act of 2010 mandated the launch

date of October 1, 2013. However, the subcontrac-

tors barely communicated with one another about

software and hardware problems in an ef‌f ort to avoid

blame (Stolberg and Shear 2013). Knowledge sharing

is a vital tool for integrating service implementation

networks (Goldsmith and Eggers 2004).  us, knowl-

edge hoarding in the implementation network may

have contributed to the Web site’s problematic rollout.

Health and human services networks are often created

to address evolving and multicausal problems, such as

serious mental illnesses (SMIs) or obesity.  e rapid

growth in medical knowledge and technology to diag-

nose and treat complex, chronic diseases makes health

services knowledge intensive (Institute of Medicine

2012). Knowledge sharing between provider organiza-

tions is a crucial f‌i rst step toward an organizational

decision to adopt and implement evidence-based

service innovations (Ferlie et al. 2013; Provan et al.

2013; Rogers 2003).

A service innovation in health care is def‌i ned as a novel

set of behaviors, routines, or ways of working that are

directed at improving health outcomes, cost ef‌f ective-

ness, or the users’ experience (Greenhalgh et al. 2004).

Agencies can develop their own

innovative solutions to problems

encountered in daily practice.

Service providers can also search

for best practices in their profes-

sional f‌i eld to import.

Knowledge Sharing in a  ird-Party-Governed Health

and Human Services Network

 e recent HealthCare.gov

f‌i asco illustrates the importance

of knowledge sharing.