title: Net benefits: assessing the effectiveness of clinical networks in Australia through qualitative methods.
abstract: BACKGROUND
  In the 21st century, government and industry are supplementing hierarchical, bureaucratic forms of organization with network forms, compatible with principles of devolved governance and decentralization of services. Clinical networks are employed as a key health policy approach to engage clinicians in improving patient care in Australia. With significant investment in such networks in Australia and internationally, it is important to assess their effectiveness and sustainability as implementation mechanisms.
  
  
  METHODS
  In two purposively selected, musculoskeletal clinical networks, members and stakeholders were interviewed to ascertain their perceptions regarding key factors relating to network effectiveness and sustainability. We adopted a three-level approach to evaluating network effectiveness: at the community, network, and member levels, across the network lifecycle.
  
  
  RESULTS
  Both networks studied are advisory networks displaying characteristics of the 'enclave' type of non-hierarchical network. They are hybrids of the mandated and natural network forms. In the short term, at member level, both networks were striving to create connectivity and collaboration of members. Over the short to medium term, at network level, both networks applied multi-disciplinary engagement in successfully developing models of care as key outputs, and disseminating information to stakeholders. In the long term, at both community and network levels, stakeholders would measure effectiveness by the broader statewide influence of the network in changing and improving practice. At community level, in the long term, stakeholders acknowledged both networks had raised the profile, and provided a 'voice' for musculoskeletal conditions, evidencing some progress with implementation of the network mission while pursuing additional implementation strategies.
  
  
  CONCLUSIONS
  This research sheds light on stakeholders' perceptions of assessing clinical network effectiveness at community, network, and member levels during the network's timeline, and on the role of networks and their contribution. Overall, stakeholders reported positive momentum and useful progress in network growth and development, and saw their networks as providing valuable mechanisms for meeting instrumental goals and pursuing collaborative interests. Network forms can prove their utility in addressing 'wicked problems,' and these Australian clinical networks present a practical approach to the difficult issue of clinician engagement in state-level implementation of best practice for improving patient care and outcomes.
authors.affiliation: Centre for Clinical Governance Research, Australian Institute of Health Innovation, Level 1, AGSM Building, University of New South Wales, Sydney, NSW 2052, Australia. f.cunningham@unsw.edu.au
authors.forename: Frances C
authors.initials: FC
authors.lastname: Cunningham
authors.forename: Geetha
authors.initials: G
authors.lastname: Ranmuthugala
authors.forename: Johanna I
authors.initials: JI
authors.lastname: Westbrook
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Braithwaite
mesh_terms: D001315:Australia; D003153:Community Health Services / Q000458:organization & administration; D003299:Cooperative Behavior; D017598:Efficiency, Organizational; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D009140:Musculoskeletal Diseases / Q000628:therapy; D036301:Qualitative Research; D058996:Quality Improvement / Q000458:organization & administration*; D013222:State Medicine / Q000458:organization & administration*