Centrality – differentiation – involvement

In the network assessment framework proposed by Brößkamp-Stone (2004) following the model by Alter & Hage (1993), centrality and differentiation are two distinct network charac-teristics applied for describing and comparing networks. Centrality, in these approaches, is understood as the degree to which information or tasks flow from one or more network

Points for the advancement from (informal) networking to (institutionalized) collaboration (min. = 0, max. = 12)

members to other members. Differentiation, on the other hand, is defined as the distribution of tasks and responsibilities between different network members. Following these definitions, higher levels of differentiation – and thus the involvement of higher numbers of actors in the fulfillment of network tasks – will at the same time automatically decrease the centrality of specified network actors and of the network as a whole. Therefore, it seems to make sense to conceptualize centrality and differentiation as a continuum on an axis from maximum differ-entiation to maximum centrality. However, the construction of HPH networks (as well as of other setting-related health promotion networks) makes the applicability of these two con-cepts difficult anyway. Because of their joint historical background and the fact that the na-tional / regional networks relating to a specific setting usually are all under the same interna-tional umbrella with regard to network rules and regulations, these networks typically share many identical features (compare chapter 3):

So as other setting-oriented health promotion networks, national / regional HPH networks typically consist of two main types of (organizational) actors, i.e. a network coordination agen-cy and the participating organizations which are usually composed of rather similar types of organizations, such as hospitals, schools, or enterprises. As these participating organizations usually have to invest (most of) their time and resources in the fulfillment of their respective core businesses – e.g. education in schools, curation in hospitals – they often happily delegate tasks relating to network coordination and the management of network activities to the dedi-cated network coordination agency, and the existence and professionalism of such agencies has been pointed out as a relevant factor for network viability and effectiveness in the network literature (e.g. Turrini et al. 2009).

Thus, while the participating organizations usually agree to work towards further develop-ing their organizations towards health promotion (on a more or less formalized basis), they almost naturally expect their national / regional coordinating agency to provide the necessary support to facilitate this endeavor. Coordination agencies in HPH networks, in this sense, can and have to be viewed as service providers for their member organizations – especially since they often are the only actors within their network disposing of specified (external) funding for network tasks or equipped with the (organizational) mandate to perform specific tasks for the whole network.

Because of this structure, comparably low levels of differentiation and comparably high levels of centrality generally have to be expected in national / regional HPH networks as well as in other national / regional setting-oriented health promotion networks³⁷ so that the con-cepts of centrality and differentiation do not appear too useful for a comparative analysis of this specific form of networks.

Therefore, this study proposes to introduce the concept of “involvement”, which would be defined as the degree to which network members are involved in deciding on or performing specific network tasks, as an alternative to the centrality-differentiation continuum. This

37 This is in contrast to the international organization of these networks. For example, on the international level, HPH has two main centers with differentiated functions (see chapter 2 for details). Similarly, “Schools for health in Europe” have several international collaborating partners with differentiated functions as well (compare Barnekow 2011).

cept seems more apt to setting-oriented health promotion networks and to health promotion concepts, since it takes up principles such as participation and empowerment. The assessment of network involvement is proposed for the following 3 dimensions:



First of all, involvement can refer to the processes of taking network decisions.



Second, involvement can refer to the distribution of operational network activities amongst the members.



Last but not least, involvement can be framed as the self-perceived involvement of HPH member organizations in their network.

To assess the involvement of network member organizations in decision-taking within their network, HPH network coordinators were asked in the PRICES-HPH network questionnaire, which of the network coordination structures in place in their networks were involved in 8 pre-defined common dimensions of decision-taking. These dimensions included decisions on network budgets, on network aims and goals, on thematic priorities, on allocating membership, on starting or terminating network events, holding network conferences, building alliances for the network, and externally representing the network. The involvement of the four most prev-alent network structures – coordinators, chairs, general assemblies and governance boards – in these 8 dimensions was assessed and was highest in network aims and lowest with regard to decisions on network budgets (see Figure 22 below).

Figure 22: Number of networks involving 4 defined network coordination structures in 8 pre-defined dimension of network decision-taking (N=28)

A suggested index on the decision-taking involvement of the networks allocates a value be-tween 0 and 100 to each network, depending on the number of network structures each net-work had in place in addition to the coordinator, and on how many of these structures were involved in decision-taking on the 8 defined areas. (see Table 25 below).

6

Table 25: Involvement of network structures in network decision-taking in 8 pre-defined areas, and total index for the networks’ decision-involvement (network means across 8 areas) (N=28)

NW-Number

Number structures in

addition to

coordinator Budget Aims Themes Starting / Closing Member- ship Conferen- ces Alliances Represen- tation Total Index³⁸

NW11 0 0 0 0 0 0 0 0 0 0,0

NW13 0 0 0 0 0 0 0 0 0 0,0

NW17 0 0 0 0 0 0 0 0 0 0,0

NW18 0 0 0 0 0 0 0 0 0 0,0

NW19 3 0 1 0 2 0 3 2 1 37,5

NW24 2 0 2 2 0 0 1 1 1 43,8

NW28 3 1 3 3 2 1 2 2 2 66,7

NW35 0 0 0 0 0 0 0 0 0 0,0

NW36 3 3 3 3 2 0 2 3 3 79,2

NW37 2 2 0 0 2 0 0 0 1 31,3

NW41 1 1 1 1 1 1 1 1 1 100,0

NW43 0 0 0 0 0 0 0 0 0 0,0

NW47 0 0 0 0 0 0 0 0 0 0,0

NW48 3 0 0 0 0 0 0 0 0 0,0

NW53 2 1 2 2 1 1 1 1 0 56,3

NW54 1 1 1 1 0 1 1 1 1 87,5

NW55 2 0 2 2 2 2 2 2 1 81,3

NW56 0 0 0 0 0 0 0 0 0 0,0

NW59 3 3 2 2 0 1 1 1 0 41,7

NW60 0 0 0 0 0 0 0 0 0 0,0

NW63 0 0 0 0 0 0 0 0 0 0,0

NW65 3 0 1 1 1 1 1 1 1 29,2

NW69 0 0 0 0 0 0 0 0 0 0,0

NW75 1 1 1 1 0 0 0 1 1 62,5

NW80 1 0 0 0 0 0 0 0 0 0,0

NW81 2 0 0 0 0 0 0 0 0 0,0

NW85 1 0 0 0 0 1 0 0 0 12,5

NW86 0 0 0 0 0 0 0 0 0 0,0

A similar approach was taken to assessing the involvement of network members in opera-tional network activities. Network coordinators were asked to describe, for those network media and activities they had in place (compare Figure 23 below), whether, in addition to the coordinator, also network members or external network partners were involved in producing or offering them.

38 Calculation: For each decision dimension, the percent of structures in place in the respective network that was involved in decision-taking in the respective dimension was calculated, with the decision-involvement index being the mean value across all decision dimensions.

Figure 23: Number of networks offering 8 pre-defined network media (N=28)

For the comparative analysis of operational involvement, those 5 media / offers that were in place in at least half of the networks – presentations, websites, conferences, publications and info packages – were included. Based on the number of activities in place and on the number of players involved in providing them (max. 3), each network was assigned a value between 0 and 100% (compare Table 26 below):

Table 26: Operational involvement of network structures in 5 pre-defined areas, and total index (network means across 5 areas) (N=28)

Network

number

Info-Package Website Conferences External

presentati-ons Publishing Total index³⁹

NW11 34 34 34 67 34 40,6

NW13 34 34 34 34 0 27,2

NW17 34 34 34 67 67 47,2

NW18 34 34 34 34 67 40,6

NW19 67 34 67 67 0 47

NW24 34 34 0 34 1 20,6

NW28 34 34 34 34 34 34

NW35 1 1 1 1 1 1

NW36 34 34 67 67 67 53,8

NW37 0 67 0 1 0 13,6

NW41 34 0 34 67 67 40,4

NW43 1 1 1 67 34 20,8

NW47 0 1 34 1 1 7,4

39 For each offer in place, each network was allocated 1 point. For each of 3 potential actors involved in providing the offer – coordinators, members, and external actors – the network was assigned 33%, resulting in max. 100% per offer. The total index value for each network was calculated as the mean across the operational involvement values for all 5 network media / activities.

4

10 13

20 21

23 25

26

0 5 10 15 20 25 30

Telephone hotline Printed Newsletter E-Newsletter Info package Publishing Conference Website External presentations

Network

number

Info-Package Website Conferences External

presentati-ons Publishing Total index³⁹

NW48 0 1 34 34 34 20,6

NW53 1 34 34 34 34 27,4

NW54 34 1 1 34 34 20,8

NW55 34 34 1 34 3 21,2

NW56 0 1 34 0 0 7

NW59 0 1 1 67 67 27,2

NW60 34 0 0 1 1 7,2

NW63 34 34 34 34 34 34

NW65 1 1 67 67 67 40,6

NW69 67 100 34 100 34 67

NW75 0 0 1 0 0 0,2

NW80 0 34 0 34 34 20,4

NW81 1 1 1 34 0 7,4

NW85 34 34 0 67 67 40,4

NW86 0 34 67 34 0 27

The third suggested aspect of network involvement, finally, was the level of involvement as perceived by HPH member organizations themselves. For assessing this level of involvement, data from the PRICES-HPH hospital survey were taken. Since hospital data were either not available, or available in too few numbers per network⁴⁰ in 5 of the 28 PRICES-HPH net-works, only 23 networks and their member hospitals could be included in a comparative anal-ysis of this dimension of involvement. Again, each of the included networks was assigned a value between 0 and 100% according to the mean level of perceived involvement reported by member hospitals (based on a linear transformation of the involvement reported by member hospitals: 1 = no involvement = 0%, 5 = full involvement = 100%, and then calculating the mean across network members) (see Figure 24 below).

40 Only networks that had a minimum of 2 member hospitals responding were included.

Figure 24: Mean degree of involvement as perceived by network member organizations in 23 HPH networks

Overall, data show clear differences between the networks with regard to the relational di-mension of “involvement”. Potential impacts of these differences on the networks’ productive and reproductive effectiveness are further analyzed in chapters 8 and 9.

In document Interorganizational networks in the settings approach of health promotion (Page 116-122)