Policy coordination and integration, trust, management and performance in public health-related policy networks: a survey
| Author | Dorothee T.J.M. Peters,Erik Hans Klijn,Janneke Harting,Karien Stronks |
| Published date | 01 March 2017 |
| Date | 01 March 2017 |
| DOI | http://doi.org/10.1177/0020852315585061 |
| Subject Matter | Articles |
Review of
Administrative
Article
Sciences
International Review of
Administrative Sciences
2017, Vol. 83(1) 200–222
Policy coordination and
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DOI: 10.1177/0020852315585061
and performance in public
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health-related policy
networks: a survey
Dorothee T.J.M. Peters
Academic Medical Centre – University of Amsterdam,
The Netherlands
Erik Hans Klijn
Erasmus University, The Netherlands
Karien Stronks
Academic Medical Centre – University of Amsterdam,
The Netherlands
Janneke Harting
Academic Medical Centre – University of Amsterdam,
The Netherlands
Abstract
Intersectoral policy networks may be effective in dealing with complex public health
problems. Their performance is assumed to depend on network management and trust,
as well as on integrated public health policy (i.e. policy coordination and integration).
We studied the role of network management and trust in the realization of integrated
public health policy and network performance, as well as the relation between
integrated public health policy and network performance. In 34 Dutch local policy
networks, we measured the perceptions of 278 actors through a Web-based survey
and used regression analyses to assess the relations between policy variables.
Management and trust were positively related to perceived integrated public health
policy and network performance, while integrated public health policy was also posi-
tively related to perceived network performance. In public health, the performance of
intersectoral policy networks may be improved by adequate network management, the
creation of trust and policy coordination and integration. Future research could further
Corresponding author:
Dorothee T.J.M. Peters, Department of Public Health, Academic Medical Centre, University of Amsterdam,
PO Box 22660, 1100 DD Amsterdam, The Netherlands.
Email: dorothee.peters@gmail.com; d.t.peters@amc.nl
Peters et al.
201
explore the role of specific characteristics of the network manager, like the manager’s
background, relation to the other actors and leadership style.
Points for practitioners
Regarding inter-sectoral policy networks in public health: first, when aiming for the real-
ization of policy coordination and integration, the employment of network management
strategies and the creation of trust are of importance for the network manager; and,
second, when also aiming for the realization of network performance, the creation of
policy coordination and integration is of additional importance for the network manager.
Keywords
Integrated public health policy, network management, network performance, policy
coordination, policy networks
Introduction
Public health issues are considered complex problems in need of complex solutions
in order to improve public health (Kickbusch and Gleicher, 2011). The complexity is
related to the various determinants that affect public health, such as individual
lifestyle factors, socio-economic, cultural and environmental factors, living and
working conditions, and community networks (Dahlgren and Whitehead, 1991;
Kickbusch, 2010). Many of these factors are situated outside the sphere of influence
of the public health policy sector itself (Kickbusch, 2010; Rittel and Webber, 1973),
meaning that other sectors possess the resources vital to influence the various deter-
minants of health, for example, judicial or economic policy instruments (Kickbusch
and Gleicher, 2011). So, a crucial part of the complex solutions needed is the
involvement of actors from other policy sectors in the development and implemen-
tation of public policies that effectively address public health issues. Such a complex
policy approach often manifests itself in intersectoral policy networks and is called
integrated public health policy (IPHP) (Kickbusch, 2010). IPHP is referred to by a
wide variety of terms, like ‘governance for health’ (Kickbusch and Gleicher, 2011),
‘health in all policies’ (e.g. Sta˚hl et al., 2006) and ‘public policies for better health’
(Kickbusch, 2013). As these terms are used inconsequently, we consider IPHP to be
an umbrella term representing all different horizontal public health policy
approaches. IPHP is assumed to result in improved network performance in
terms of innovative policies capable of addressing the various determinants of
health, and, ultimately, public health gain. Therefore, IPHP is considered a promis-
ing policy concept to promote health (Kickbusch, 2010).
There is also some scepticism regarding the use and effectiveness of IPHP
(Kickbusch, 2010; Mannheimer et al., 2007; Ollila, 2011; Sta˚hl et al., 2006).
Bringing together public health and non-public health actors in policy networks
creates dependency relations around the resources necessary to counteract the
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International Review of Administrative Sciences 83(1)
various determinants of health (Hanf and Scharpf, 1978; Kickbusch, 2010;
Koppenjan and Klijn, 2004). Complexity increases since network actors are
autonomous (Koppenjan and Klijn, 2014): they cannot be forced to collaborate
and can withdraw from agreements, for example, on the availability of specific
resources in the network. Furthermore, actors from different sectors may have
different perceptions of the problem, and thus of the solutions, which may result
in conflicting strategies, leading to stagnation and deadlocks in the policy process
(Van Bueren et al., 2003). The growing literature on networks in Public
Administration suggests that network management (McGuire and Agranoff,
2011; Mandell, 2001) and trust (Klijn et al., 2010b; Nooteboom, 2002; Provan
et al., 2009) between network actors may reduce the adverse effects of dependen-
cies and actors’ autonomy in IPHP networks, and thus improve network perform-
ance in terms of policy innovation and public health gain. However, this literature
includes hardly any replication research on these claims, while, at the same time, it
indicates that achieving effectiveness in network performance is not easy. Most
research is done on a limited number of cases in the health-care sector (see Isett
et al., 2011; Provan et al., 2009), and there are a few studies on other sectors (Klijn
et al., 2010a; Meier and O’Toole, 2007). In addition, in the public health literature,
the presumed claim of IPHP resulting in positive network performance in terms of
policy innovations and health gain has not been studied so far. With our large-scale
survey study, we intend to address both issues.
We studied the presumed relations between management, trust, IPHP and
network performance within the context of the Gezonde Slagkracht (Decisive
Action for Health) programme (2009–2014). In this programme, the Dutch
Ministry of Health, Welfare and Sports offered municipalities the opportunity to
experiment with IPHP and thus to build (new) policy networks in order to improve
public health. The focus of these networks was policy development and service
delivery. In total, 34 municipalities and alliances of municipalities (referred to
later as projects) were rewarded with participation in the programme. The projects
were encouraged to develop an integrated policy strategy that fitted the local situ-
ation best, while taking into account specific health themes, that is, the prevention
of obesity, alcohol and drugs abuse, and smoking. The programme consisted of
financial and professional support. Examples of projects studied in the Decisive
Action for Health programme are as follows:
Obesity project: Initiated by the regional public health services, this project aimed
to promote a healthy lifestyle among children. The project used a single lifestyle
intervention in which obese children attended special sports lessons. The actors
involved were from the policy sectors of public health and sports. Actors included
both public (e.g. regional public policy departments) and private organizations
(e.g. sports club, health insurance company).
Alcohol project: Initiated by two policy departments, namely, public safety and
public health, this project aimed at reducing excessive drinking and changing the
existing heavy drinking culture in village communities. The project used a mix of
Peters et al.
203
communication (e.g. instruction and education) and legal instruments (e.g. coven-
ants between the municipality and sports clubs). Actors involved were both public
(e.g. several policy departments, police, fire brigade) and private actors (e.g. sports
clubs, a discotheque).
All-themes project: This project aimed at creating a permanent level of instruments to
prevent obesity, depression, alcohol abuse and early school leaving in order to
enhance citizens’ ability to cope independently. The project used a mix of lifestyle
interventions, embedded in a permanent network of public services in policy sectors
like education, public safety, social work and public health, with public, semi-public
and private actors involved. The initiator of this project is unknown.
The aims of this study were: (1) to investigate the role of trust and network
management in the realization of both IPHP and network performance, as well as
the relation between the two variables; and (2) to explore whether IPHP had a
mediating role in the relation between network management and trust, on the one
hand, and network performance, on the other.
Theoretical framework
Policy networks, like the IPHP networks, can roughly be defined as ‘more or less
stable patterns of social relations between mutual...
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