Co-creation within hybrid networks: what can be learnt from the difficulties encountered? The example of the fight against blood- and sexually-transmitted infections
| Published date | 01 September 2018 |
| DOI | 10.1177/0020852317741679 |
| Author | Nassera Touati,Lara Maillet |
| Date | 01 September 2018 |
| Subject Matter | Special issue on Making connections: Hybrid networks and public action, Guest editors: Nassera Touati and Deena WhiteSpecial Issue Articles |
Review of
Administrative
Article
Sciences
International Review of
Co-creation within
Administrative Sciences
2018, Vol. 84(3) 469–485
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hybrid networks: what
The Author(s) 2018
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can be learnt from the
DOI: 10.1177/0020852317741679
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difficulties encountered?
The example of the fight
against blood- and
sexually-transmitted
infections
Nassera Touati
E´cole nationale d’administration publique, Canada
Lara Maillet
Institut Universitaire de premie`re ligne en sante´ et services
sociaux, Canada
Abstract
This article analyses co-creation processes within hybrid networks. Specifically, it looks
at a particular co-creation mechanism, in this case, a strategic community set up to test
new ways of dealing with blood- and sexually-transmitted infections in Quebec.
A strategic community is a temporary structure of inter-organizational collaboration,
made up of professionals, first-level managers, general practitioners, representatives of
community organizations, etc. tasked with generating, implementing and evaluating new
ideas about the organization of services. The results of this study highlight the difficul-
ties encountered as well as the issues related to these co-creation processes.
Corresponding author:
Professor Nassera Touati, E´cole nationale d’administration publique, Que´bec, Canada.
Email: nassera.touati@enap.ca
470
International Review of Administrative Sciences 84(3)
Notes for practitioners
The implementation of co-creation processes, involving public, private and community
actors, has to contend with numerous challenges: (1) the enrolment of the stakeholders
concerned by the complex issues; (2) the creation of places for discussion and exper-
imentation involving actors who play an important role in the implementation of
change; (3) the mobilization of tools and facilitators to develop a common vision; (4)
the action stage to validate new ways of doing things.
Keywords
networks, service delivery, strategy
Introduction
In a context of financial crisis, of spiralling demand for public services and the
emergence of complex problems, innovation is seen as unavoidable (Osborne and
Brown, 2011). Innovation is a process involving the generation, adoption and
dissemination of new ideas intended to produce a ‘qualitative’ change in the par-
ticular context of an organization (Sørensen and Torfing, 2011). To encourage its
emergence, authors put forward the idea of collaboration between interdependent
actors, giving rise to the concept of collaborative innovation (Bland et al., 2010;
Sørensen and Torfing, 2011; Torfing and Ansell, 2017). However, these very same
authors are aware that collaboration does not necessarily lead to innovation.
Several factors may hamper the emergence of innovation, including: cognitive
and identity barriers (Ferlie et al., 2005); coordination difficulties (Swan and
Scarbrough, 2005), closure and stability of networks (Skilton and Dooley, 2010),
high level of uncertainty (O’Toole, 1997); the difficulties of developing a collective
intelligence (Lafaye and Berger-Douce, 2014).
Beyond highlighting the obstacles to innovation, some authors invite us to
analyse the conditions and levers that encourage innovation, by examining the
potential of the co-creation processes (Torfing et al., 2016). The latter refer to
the processes of solving common problems through constructive exchanges of
different types of knowledge, skills, ideas and resources. The aim is to better
understand how these co-creation processes are implemented and lead to innova-
tions (Torfing et al., 2016). The few works that exist (Sørensen and Torfing, 2016,
2017) suggest that co-creation processes ‘succeed’ when they create alliances
between a variety of actors with different assets and recruit committed and com-
petent actors. Despite their interest, these empirical studies do not make it possible
to grasp the issues at play within the context of hybrid networks, where the stake-
holders are influenced by different institutional logics. That is why in this article we
address the following research question: How and in what context can co-creation
processes in hybrid networks lead to innovative practices?
Touati and Maillet
471
More precisely, we will look at a particular co-creation mechanism, in this case
strategic communities, tested in the health and social sector in Quebec. These are
temporary structures of inter-organizational collaboration, made up of professionals,
first-level managers, general practitioners, representatives of community organiza-
tions, etc. tasked with generating, implementing and evaluating new ideas about
the organization of inter-institutional work (Audet and Roy, 2016). These com-
munities favour a bottom-up approach to change and, with the help of a facilitator
adviser and an animator, strive to develop reflexive and experimental spaces to
renew organizational practices. Strategic communities report to a management
committee.
Context of the study: the socio-sanitary system in Quebec
Over the years, governance in Quebec has been gradually decentralized. Until
April 2015, roles were assigned to regional agencies: public health functions, coor-
dination of local service networks at the regional level, and allocation of budgets to
the institutions. At the local level, health and social services centres (CSSSs) were
responsible for the health of the population of their territory and, as such, had to
offer a wide range of services in collaboration with other partners within the local
service network. These centres were also called upon to act on a set of health
determinants and therefore had to develop intersectoral collaborations. In April
2015, a reform completely transformed the health network: regional agencies were
abolished, integrated health and social services centres (CISSS) were created,
resulting from the merger of regional agencies and institutions in the region, and
the powers of the Ministry of Health have been substantially strengthened.
Our study focuses on a pilot project rolled out in a territory on the Island of
Montreal that set out to test new ways of dealing with blood- and sexually-
transmitted infections.
Framework of the analysis
Our analysis will be based on actor-network theory (Callon, 1986), which allows us
to explain how, despite the fragmentation of power and non-convergence of goals,
it is possible to build support networks around definitions of a technical subject
that will become accepted by all. In concrete terms, a technical object or a strategy
exists from such time as its existence is recognized by a network of human and
non-human actors. This becomes possible through a process of translation, capa-
ble of overcoming the controversies. The term ‘translation’ refers to all negotia-
tions, conspiracies, acts of persuasion, calculations or acts of violence by which an
actor or a force takes the liberty or is given authority to speak or act on behalf of
another actor or other force (Akrich et al., 2006: 13). This translation involves the
following steps: (1) problematization (a stage during which the translators identify
a problem and potential solutions, and ensure that innovation becomes an oblig-
atory passage point for all the actors concerned if they want to reach their
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International Review of Administrative Sciences 84(3)
objectives), (2) interessement (determination and pinpointing of interests to ensure
that the actors continue to support the emerging project), (3) enrolment (result of
successful interessement) and (4) mobilization (creation of a critical mass of con-
nected actors) potentially leading to the irreversibility of a strategy. Innovation
processes are therefore essentially interessement processes, which are based on
intermediaries (e.g. money, competent people, documents, etc.), which are entities
carrying meanings or forces.
Methodology
Our research strategy is a longitudinal case study (Stake, 1995) conducted between
November 2014 and November 2016. This research was based on 28 semi-
structured interviews with members of the strategic community and the manage-
ment committee (17); the facilitator adviser (2); animator (1); the managers/
professionals of the CSSS (5); and the representatives of partner organizations
approached by the project carriers (3). In these interviews, we asked respondents
about their perceptions of issues relating to the fight against blood- and sexually-
transmitted infections, their understanding of the pilot project, their role, the
functioning of the committees, their perception of the relevance of the recommen-
dations of the strategic community, the difficulties encountered, the efforts made to
overcome these difficulties, etc. All interviews were transcribed and coded using
Nvivo10. Our coding adopted an inductive and deductive approach, based on our
interview grid. This data source was supplemented by document analysis (21
minutes of meetings, taken by the facilitator adviser, change artefacts such as
draft agreements between organizations, tools used in meetings, etc.) and by the
observation of meetings of the strategic community and the management commit-
tee (21 hours of observation). These observations were intended to capture con-
troversies, negotiation processes, the role of intermediaries, etc. Our role as an
observer was accepted, in exchange for feedback on our analysis.
All of these data were the subject of a process analysis (Langley, 1999). We first
constructed a narrative to arrive...
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