How do clinical networks operationalize safety and quality stewardship? A qualitative study of Australian clinical networks.

backgroundHealth system stewardship involves steering and oversight through authoritative vision-setting, effectively intervening and influencing within the health system, and placing high-value on evidence. Governments apply a multitude of strategies to assure the safety and quality of clinical care. Governments have predominately relied upon hierarchy and markets to influence health systems, but both have demonstrated limitations resulting in increased interest in networks. Clinical networks are groups that traverse institutional and professional boundaries to define and support the adoption of expectations for evidence-based care. Well-established across Australia, the unique contribution of clinical networks to stewardship and safety and quality aims has yet to be examined.

methodsA qualitative study was conducted to examine how Australian clinical networks operationalize stewardship. Methods involved interviews at the national level and comparative case study of three clinical networks within the state of Victoria. Semi-structured interviews were conducted involving government public service representatives, network managers, leads and members (n = 47). A blended deductive and inductive thematic analytical approach was applied.

resultsFindings show that the execution of safety and quality stewardship must rely on a binding structure, such as networks, to coordinate diverse actors whose behaviours and decisions ultimately affect clinical care. Networks collaborate to develop a shared vision for services, placing reliance on socially mediated influence to motivate actors to act in accordance with the vision. Yet safety and quality problems can be wicked and opaque, necessitating the use of diverse evidence types to understand problems and develop solutions that can be implemented. Networks balance evidence quality and applicability to context, elevating the importance of capability in evidence use.

conclusionsEmpirical contributions show the necessity of networks to execute safety and quality stewardship as a shared responsibility of actors. Stewardship is not a function of governments alone. Findings show the necessity of motivation at the level of the individual to shape understanding, behaviours and quality of actor decision-making. Evidence of all types retain an instrumental role in building knowledge as a form of influence. This research argues that health system stewardship, networks and evidence use need to be considered in an interdependent way to realize safety and quality aims.