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.
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.
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
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.