Some attention must be paid to the collected data and the analysis that led to these findings and contributions. My dissertation is fully based on qualitative data, each chapter focusing on a single case study. Having been particularly interested in examining developmental processes and practices, I aimed for depth of insight and – where possible – longitudinal involvement instead of breadth. This choice brings with it issues of generalizability – which I will address below – but could also arguably affect the robustness of my findings. I have strived to ease such concerns by triangulating my data whenever possible, in a number of ways. Interview, observation, and archival data were frequently combined – in twos and threes across different studies. Beyond this, I have carefully cross-referenced and compared information from different respondents – across departments, organizations, and functions. With regard to the networks themselves, my first case study being embedded allowed for a certain degree of comparison across the inter-organizational relationships developed between different combinations of departments. In the case of the second network, comparisons could be drawn between the strategizing actors’ intra-network interactions and their interactions with the actors external to the network. Moreover, the textual artefacts used to study its development – among which a significant number of email conversations – served to provide a well- sourced view on the case.
In my analysis, I strived to avoid confirmation bias by consistently approaching the data starting from sensitising concepts, as opposed to a predefined theoretical framework. With only the sensitising concepts in mind, I first developed an understanding of each case and its actors, and then iteratively moved between theory and data in a way that allowed the findings and theorizing insights to emerge in a non-directed fashion. Moreover, I frequently consulted with my supervisors, establishing them as devil’s advocates (Nemeth et al., 2001) who, as parties external to the unfolding cases and the analysis itself, could reflect on the sense and strength of my findings.
Finally, I have tried throughout this dissertation to approach my findings in a manner that acknowledges their contextual and methodological limitations. In the case of all three studies, the main limitation has been the fact that I examined network development retrospectively. Both of the networks I studied had already been undergoing the inter-organizational development processes
when I approached them; by the time access negotiations ended, so too had these processes. Due to time restrictions, I then proceeded with the retrospective analyses presented in the previous chapters. This does not, however, discount my findings, as the existing data and the measures I took to avoid recall bias ensured that it could still provide useful insights. On the one hand, this involved conducting observations and using extensive archival data. On the other, it consisted of cross-referencing interview data across respondents and sources.
Subsequent limitations result from my single case study based analysis, which embeds my results in the organizational contexts from which they were drawn. Some of the findings may be relevant for top-down oriented, transactive collaborations, while others may only be representative of bottom- up, transformative ones; all of them may be specific to hub-oriented networks in a Dutch healthcare context. That being said, my findings are predominantly exploratory. As such, they give strong indications of the existence of new concepts, relationships, or conceptualizations – however, they also indicate that future research on these issues should be conducted in different settings to help improve our understanding of them. In that sense, my findings do not greatly differ from those typical of qualitative studies.
Along with suggestions for future research determined by my methodological constraints, my dissertation also provides some new directions based on interesting findings that require a more focused examination. One example concerns the replacement of one or more boundary spanners and its potential impact on the collaborative process and outcome. This issue featured in all three of my studies, yet could not be explored in enough depth in any of them. In Chapter 2, inconstant boundary spanners were identified as a potential risk to the collaboration, as removing certain key actors would also have broken down key lines of communication. In Chapter 3, the insurance company’s inconstant boundary spanner required new efforts to span the semantic boundaries between the company and the network, with an ultimately negative impact on the strategizing process. Finally, in Chapter 4, the entire inter-organizational operational process was arguably kick-started with the hospital’s removal of key boundary spanners. As time went by, the hospital’s nominated boundary spanners became boundary spanners-in-practice and thus successfully replaced the previous boundary spanners. Although this ultimately led to a more effective collaboration, the initial removal still caused a great deal of unrest and inefficiency in the organizations’ operations. On this backdrop,
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some possible questions that future research could explore are: Under what conditions – if any – can boundary spanners be removed without negatively impacting one or both communities connected by those actors? From a slightly different perspective, how does removing one or more members of a group of boundary spanners impact the collaboration between that group and its boundary spanning counterpart?
Another avenue for future research relates to transformative and transactive boundary spanning (Levina & Vaast, 2013), and their relationship with the knowledge boundaries between the communities or actors involved. Recent boundary spanning research seems to suggest that, since pragmatic boundaries are spanned by jointly creating new knowledge (Carlile, 2002, 2004), they are generally handled through transformative boundary spanning (Levina & Vaast, 2013). However, in the networks I studied, this was not always the case. In the first network, the boundary spanning actors involved in elaborating the network’s policies and procedures came together to negotiate their different interests, and the repercussions of introducing an altered patient transfer practice (Chapter 2). Thus, they engaged in transformative boundary spanning in order to implement a practice that was ultimately transactive in nature (Chapter 4). In the case of the second network (Chapter 3), the boundary spanning actors also elaborated the network’s policies and procedures, but their strategizing process was predominantly enacted through transactive boundary spanning (transferring information across the syntactic organizational boundaries). This was because, although the policies and procedures they were proposing would generate a fundamental shift in the region’s patient care, all the GynOncNet parties welcomed the change. This was not the case for the region’s insurance company, whose interests were in conflict with the network’s proposed policies (albeit only on a financial level). And yet, as previously mentioned, the network’s interactions with the insurance company were closer to a transactive boundary spanning process.
On the one hand, the fact that actors can move between the two boundary spanning modes – whether inadvertently or not – in the process of working together has already been posited by the literature (Levina & Vaast, 2013); my dissertation, in this case, only provides further empirical examples of these moves. On the other hand, these examples suggest that actors may engage in transactive boundary spanners even when aware of the pragmatic issues at stake, a type of interaction which – to the best of my knowledge – has not yet been
expressly studied. Considering this, a review of the extant empirical research on boundary spanning forms could identify relevant examples of transactive and transformative boundary spanning, and determine whether they correspond with the actual knowledge boundaries between the collaborating parties. Empirical research extending my insights on the topic could follow.