title: A catalyst for system change: a case study of child health network formation, evolution and sustainability in Canada.
abstract: The purpose of this study was to examine key processes and supportive and inhibiting factors involved in the development, evolution, and sustainability of a child health network in rural Canada. This study contributes to a relatively new research agenda aimed at understanding inter-organizational and cross-sectoral health networks. These networks encourage collaboration focusing on complex issues impacting health - issues that individual agencies cannot effectively address alone. This paper presents an overview of the study findings.
  
  
  
  An explanatory qualitative case study approach examined the Network's 13-year lifespan. Data sources were documents and Network members, including regional and 71 provincial senior managers from 11 child and youth service sectors. Data were collected through 34 individual interviews and a review of 127 documents. Interview data were analyzed using framework analysis methods; Prior's approach guided document analysis.
  
  
  
  Three themes related to network development, evolution and sustainability were identified: (a) Network relationships as system triggers, (b) Network-mediated system responsiveness, and (c) Network practice as political.
  
  
  
  Study findings have important implications for network organizational development, collaborative practice, interprofessional education, public policy, and public system responsiveness research. Findings suggest it is important to explicitly focus on relationships and multi-level socio-political contexts, such as supportive policy environments, in understanding health networks. The dynamic interplay among the Network members; central supportive and inhibiting factors; and micro-, meso-, and macro-organizational contexts was identified.
authors.affiliation: School of Nursing, Faculty of Science, St. Francis Xavier University, Box 5000, Antigonish, Nova Scotia, B2G 2W5, Canada. cmcpherso@stfx.ca.
authors.forename: Charmaine
authors.identifier: 0000-0001-7501-4851
authors.initials: C
authors.lastname: McPherson
authors.affiliation: School of Nursing, Faculty of Health Sciences, McMaster University, 1200 Main Street West, Hamilton, Ontario, L8N 3Z5, Canada.
authors.forename: Jenny
authors.initials: J
authors.lastname: Ploeg
authors.affiliation: School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, KlH 8M5, Canada.
authors.forename: Nancy
authors.initials: N
authors.lastname: Edwards
authors.affiliation: School of Nursing, Faculty of Health Sciences, McMaster University, 1200 Main Street West, Hamilton, Ontario, L8N 3Z5, Canada.
authors.forename: Donna
authors.initials: D
authors.lastname: Ciliska
authors.affiliation: School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, KlH 8M5, Canada.
authors.forename: Wendy
authors.initials: W
authors.lastname: Sword
mesh_terms: D000293:Adolescent; D000328:Adult; D002170:Canada; D002648:Child; D000067576:Child Health; D019058:Community Networks; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D006801:Humans; D008875:Middle Aged; D019982:Organizational Case Studies; D036301:Qualitative Research; D019035:Rural Health Services
keywords: Case study methods; Child and youth health; Collective impact approach; Cross-sectoral; Health network; Inter-organizational; Interprofessional collaboration; Place-based approach; Policy and politics; System responsiveness