The Ethnography of Caring Networks: Disentangling a governance order in-the-making

Whilst creating, nurturing, and maintaining networks is increasingly seen as a solution to pressing healthcare issues like growing older person populations and workforce shortages, governing them is becoming more and more part of a healthcare manager’s job and daily routine. Networks require the reconfiguration of entrenched professional, organizational, administrative, geographical, and institutional boundaries. This re-puzzling of healthcare governance is at the heart of this exploratory and empirically-grounded dissertation. The overall research question is as follows: How does networking unfold in the everyday governance actions and interactions of affected actors, and with which consequences does this come for their role and work?

Inspired by a practice-based understanding of networks, this dissertation signals an empirical deficit within network scholarship for ‘everyday governance’ in a multi-network context. Tracing the relational connections that are a feature of networking as it is lived in specific situations may help generate empirically-grounded knowledge for healthcare management. By adopting a multi-sited ethnography in the context of Dutch healthcare governance—particularly centered around actors involved in older person and hospital care, the ethnographic work covers in-depth interviews, (non-)participant observations, and document analysis. The selected cases of networking are diverse in terms of geographical place, origin and (institutional) history. Interestingly, the creation of networks is considered among policymakers an important means to (re)organize care. Paradoxically, this must occur within a healthcare system of regulated competition. By following an abductive logic of inquiry and analysis, I iteratively moved back and forth between empirical data and theoretical work about network and collaborative governance.

The ethnographic work conducted put forward the doings, workings, and meanings of caring networks. The multiplicity of networks shows that networking is no standalone activity within the boundaries of a network, but is tied with nodes of multiple networks. Ongoing entails that networking has no clear stop, but requires continuous work while navigating organizational, epistemic, and normative ambiguities that have to be processed over and over again. Place-based means that networking cannot be decoupled from the sociocultural, institutional, and geographical context in which it is aimed to have an effect. Multi-layered means that networking is embedded in underlying dynamics like professional-management relations and interactions, but also ties into broader governance structures. Multi-purpose encompasses the various ways that purposes come into being through networking, underscoring the sensemaking possibilities for actors. Networking is thus not static, but dynamic—full of ambiguities and relational processes in which interactions and structures are made and unmade.

The ethnography of caring networks contributes to our comprehension of how a grand narrative of network governance unfolds in healthcare. There is a need for a critical-pragmatist understanding of caring networks for which the following dimensions provide conceptual enrichment into the relational work required during the making process of a new governance order: caring about networks as a matter of societal concern to foster engaged learning; caring through networks to harness actors’ strategic values; caring for network purposes and ambitions to enable diverse engagement; and crafting the place to network to develop suitable responses to local needs. These dimensions stimulate deliberate reflection, involving discussion about how this making process reconfigures the relations and interdependencies in the continuum of healthcare governance: between policymakers, internal and external regulators, and healthcare practitioners; between the network of collaborations and healthcare managers; and between shop-floor professionals, informal caregivers and patients.