Network‐building by community actors to develop capacities for coproduction of health services following reforms: A case study

Abstract Introduction Responsive, integrated and sustainable health systems require that communities take an active role in service design and delivery. Much of the current literature focuses on provider‐led initiatives to gain community input, raising concerns about power imbalances inherent in inv...

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Main Authors: Susan Usher, Jean‐Louis Denis
Format: Article
Language:English
Published: Wiley 2022-10-01
Series:Health Expectations
Subjects:
Online Access:https://doi.org/10.1111/hex.13491
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author Susan Usher
Jean‐Louis Denis
author_facet Susan Usher
Jean‐Louis Denis
author_sort Susan Usher
collection DOAJ
description Abstract Introduction Responsive, integrated and sustainable health systems require that communities take an active role in service design and delivery. Much of the current literature focuses on provider‐led initiatives to gain community input, raising concerns about power imbalances inherent in invited forms of participation. This paper provides an alternate view, exploring how, in a period following reforms, community actors forge network alliances to (re)gain legitimacy and capacities to coproduce health services with system providers. Methods A longitudinal case study traced the network‐building efforts over 3 years of a working group formed by citizens and community actors working with seniors, minorities, recent immigrants, youth and people with disabilities. The group came together over concerns about reforms that impacted access to health services and the ability of community groups to mediate access for vulnerable community residents. Data were collected from observation of the group's meetings and activities, documents circulated within and by the group, and semi‐directed interviews. The first stage of analysis used social network mapping to reveal the network development achieved by the working group; a second traced network maturation, based on actor–network theory. Results Network mapping revealed how the working group mobilized existing links and created new links with health system actors to explore access issues. Problematization appeared as an especially important stage in network development in the context of reforms that disrupted existing collaborative relationships and introduced new structures and processes. Conclusion Network‐building strategies enable community actors to enhance their capacity for coproduction. A key contribution lies in the creation of ‘organizational infrastructure’. Patient or Public Contribution The lead researcher was embedded over 3 years in the activities of the community groups and community residents. Several group members provided comments on an initial draft of this paper. To preserve the anonymity of the group, their names do not appear in the acknowledgements section.
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spelling doaj.art-da40c20e9edd47e581147552be9638f12022-12-22T02:37:31ZengWileyHealth Expectations1369-65131369-76252022-10-012552275228610.1111/hex.13491Network‐building by community actors to develop capacities for coproduction of health services following reforms: A case studySusan Usher0Jean‐Louis Denis1Département de gestion, d'évaluation et de politique de santé École nationale d'administration publique Montréal Québec CanadaAnalyse et management des politiques publiques, École de santé publique Université de Montréal Montréal Québec CanadaAbstract Introduction Responsive, integrated and sustainable health systems require that communities take an active role in service design and delivery. Much of the current literature focuses on provider‐led initiatives to gain community input, raising concerns about power imbalances inherent in invited forms of participation. This paper provides an alternate view, exploring how, in a period following reforms, community actors forge network alliances to (re)gain legitimacy and capacities to coproduce health services with system providers. Methods A longitudinal case study traced the network‐building efforts over 3 years of a working group formed by citizens and community actors working with seniors, minorities, recent immigrants, youth and people with disabilities. The group came together over concerns about reforms that impacted access to health services and the ability of community groups to mediate access for vulnerable community residents. Data were collected from observation of the group's meetings and activities, documents circulated within and by the group, and semi‐directed interviews. The first stage of analysis used social network mapping to reveal the network development achieved by the working group; a second traced network maturation, based on actor–network theory. Results Network mapping revealed how the working group mobilized existing links and created new links with health system actors to explore access issues. Problematization appeared as an especially important stage in network development in the context of reforms that disrupted existing collaborative relationships and introduced new structures and processes. Conclusion Network‐building strategies enable community actors to enhance their capacity for coproduction. A key contribution lies in the creation of ‘organizational infrastructure’. Patient or Public Contribution The lead researcher was embedded over 3 years in the activities of the community groups and community residents. Several group members provided comments on an initial draft of this paper. To preserve the anonymity of the group, their names do not appear in the acknowledgements section.https://doi.org/10.1111/hex.13491actor–network theorycommunity engagementcoproductionhealth reformsnetworksQuébec
spellingShingle Susan Usher
Jean‐Louis Denis
Network‐building by community actors to develop capacities for coproduction of health services following reforms: A case study
Health Expectations
actor–network theory
community engagement
coproduction
health reforms
networks
Québec
title Network‐building by community actors to develop capacities for coproduction of health services following reforms: A case study
title_full Network‐building by community actors to develop capacities for coproduction of health services following reforms: A case study
title_fullStr Network‐building by community actors to develop capacities for coproduction of health services following reforms: A case study
title_full_unstemmed Network‐building by community actors to develop capacities for coproduction of health services following reforms: A case study
title_short Network‐building by community actors to develop capacities for coproduction of health services following reforms: A case study
title_sort network building by community actors to develop capacities for coproduction of health services following reforms a case study
topic actor–network theory
community engagement
coproduction
health reforms
networks
Québec
url https://doi.org/10.1111/hex.13491
work_keys_str_mv AT susanusher networkbuildingbycommunityactorstodevelopcapacitiesforcoproductionofhealthservicesfollowingreformsacasestudy
AT jeanlouisdenis networkbuildingbycommunityactorstodevelopcapacitiesforcoproductionofhealthservicesfollowingreformsacasestudy