Funcionarios

Explicit referrals to concepts of “networking” or “network effectiveness” are rare in the published literature on health promotion, and there is practically no overlap with wider net-work theory or netnet-work research. Brößkamp-Stone’s “Multi-Facetted Interorganizational Network Assessment Framework” (Brößkamp-Stone 2004) which was in the meantime also used for the evaluation of the German Network of Health Promoting Universities (Stock et al.

2010, Milz 2010), is an exception that will be described in the following.

Brößkamp-Stone (2004) tested the applicability of a whole-network model which was de-veloped by the American network scholars Catherine Alter and Gerald Hage (1993) to health promotion by using the European Network of Health Promoting Schools as example. The original model was developed as a framework to distinguish vertical cooperation in the indus-try and public sector from more horizontal approaches oriented at the common interests of the participants (framed as “symbiotic cooperation” by the authors) (compare Figure 5 below).

Figure 5: Brößkamp-Stone’s “Multi-Facetted Interorganizational Network Assessment Framework”

(compare Brößkamp-Stone 2004, p190)

Parts of the model – structures and processes of networks as conditioning their outcomes – seem to follow a quality approach (in the sense of Donabedian [1966]). However, the model does not conceptualize interaction effects between structures and processes which are depict-ed as impacting on the expectdepict-ed and observdepict-ed outcomes independently.

While structures, in quality models, are usually understood as organizational structures (e.g.

resources, organizational policies, organizational units, workforce), the network structures in the Alter & Hage model combine three quantitative features that originally stem from social network analysis (SNA) – size, centrality, and connectedness – with two more qualitative fea-tures, i.e. the complexity and differentiation of the network. All together, they can be inter-preted as relational network structures. In short, these five features are defined as follows:



Size: The number of organizations involved;

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Centrality: The degree to which the flow of information or tasks is dominated by one or more network members;

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Complexity: The number of different sectors or institutions in the network (synony-mous to homogeneity or heterogeneity);

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Differentiation: Functional differentiation / distribution of tasks and responsibilities be-tween the network members;

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Connectivity / connectedness: The degree to which the potential ties between the network members are actually used (resembling the “density” concept in social network analy-sis).

The process part of the model distinguishes between administrative and operative network coordination, the first of which can be understood as the coordination of communication and cooperation between the network partners for purposes of decision-making, the second as the coordination of network performance (i.e. the coordination of those tasks that have been de-cided on by means of administrative coordination).

The outcome dimension of the network can, depending on the network’s tasks, comprise outcomes on the level of the whole network (e.g. the network’s ability to provide specific ser-vices), on the level of member organizations (e.g. organizational change), and on the level of individuals (e.g. better health). And the model also contains, as unintended outcome, the po-tential for conflict between the cooperating partners²⁴.

In addition to these structures, processes and outcomes, the model also introduces context factors or “network forming factors” which makes it in principle very connective to health promotion thinking. These context factors include external control (autonomy or resource de-pendence of the network), but also the network’s goals and tasks.

While the merits of the model lie especially in its introduction of a general quality scheme to analyzing the effectiveness of interorganizational networks, it appears – for application in health promotion – problematic for several reasons:



Context or network forming factors: The model introduces resource dependence and net-work autonomy as relevant factors for netnet-work formation. However, since the pur-pose of health promotion networks, as outlined in chapter 3, can be described as ena-bling change in organizational settings, “context” should not only be understood as relevant external environments of the organizations the network works with but also as preconditions within the addressed organizations. In health promotion, the notion of “or-ganizational readiness” (compare e.g. Rütten et al. 2009) could serve that purpose. Fur-thermore, an adaptation of the second context factor in the model by Brößkamp-Stone – which was framed as “technologies” in Alter & Hage’s original version, and reduced to task and scope by Brößkamp-Stone – appears problematic, since, in addi-tion to the indisputable impact of the proclaimed task and scope of a network on its further formation and development, technology – understood both as communication tools (web platforms, skype, etc.) and intervention tools (e.g. organizational develop-ment tools) – certainly, too, has an impact on the formation of health promotion net-works, and on the way networks organize communication and performance.

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Network structures: Network research, especially when using SNA as a method, generally uses concepts like centrality to describe a given network’s structure. While these struc-tures are generally related to concepts of advantages or disadvantages they bring about, the structural features in Brößkamp-Stone’s model are hardly associated with explana-tory value in relation to network outcome (e.g. concepts like size or complexity are not further related to supportive or hindering factors for network performance and out-come). Furthermore, it seems problematic that the model leaves out “classic” structur-al features or capacities such as resources, available staff, policies etc. (which are only partly captured by the model’s “external control” dimension in form of resource de-pendency or autonomy), as they would also be expected to have an impact on network outcome.



Network processes: While the distinction between administrative and operational coordi-nation seems to make sense for distinguishing between different types of network processes (the first referring to the network’s self-reproduction, the second to its

24 The risk of conflict is also stressed by Turrini et al. They associate conflict with an increase in inequalities, as an unintended side effect of networking (Turrini et al. 2009, p14; compare also chapter 3.1.4)

duction), Brößkamp-Stone did not further explicate the specific operations a health promotion network should provide in order to best serve its purpose of supporting the uptake of health promotion in participating organizations, so that the model re-mains rather abstract.

4.5 What desired effects or outcomes do networks

In document 1.1. LAS TAREAS PRIORITARIAS DEL PERIODO 2008-2010 (página 31-34)