Network as systems: A case study of the World Health Organisation's Global Health Workforce Alliance

Journal article

Purpose

This paper presents a case study of the WHO’s Global Healthcare Workforce Alliance (GHWA). Based on a commissioned evaluation of GHWA, it applies network theory and key concepts from systems thinking to explore network emergence, effectiveness and evolution to over a 10-year period. The research was designed to provide high-level strategic guidance for further evolution of global governance in human resources for health (HRH).

Design/methodology/approach

Methods included (1) a review of published literature on HRH governance and current practice in the field and (2) an in-depth case study whose main data sources were relevant GHWA background documents and key informant interviews with GHWA leaders, staff and stakeholders. Sampling was purposive and at a senior level, focusing on Board members, Executive Directors, funders and academics. Data were analysed thematically with reference to systems theory and Shiffman’s theory of network development.

Findings

Five key lessons emerged: (1) effective management and leadership are critical; (2) networks need to balance “tight” and “loose” approaches to their structure and processes; (3) an active communication strategy is key to create and maintain support; (4) the goals, priorities, and membership must be carefully focused; and (5) the network needs to support shared measurement of progress on agreed-upon goals. Shiffman’s middle-range network theory is a useful tool when guided by the principles of complex systems that illuminate dynamic situations and shifting interests as global alliances evolve.

Research Limitations

The study was implemented at the end of the 10-year funding cycle. A more continuous evaluation throughout the term would have provided richer understanding of issues. Experience and perspectives at the country level were not assessed.

Practical Implications

Design and management of large, complex networks requires ongoing attention to key issues like leadership, and flexible structures and processes to accommodate the dynamic reality of these networks.

Originality/value

This case study builds on growing interest in the role of networks to foster large-scale change. The particular value rests on the longitudinal perspective on the evolution of a large, complex global network, and the use of theory to guide understanding.

Authors: Greenhalgh, T; Best, A; Berland, A; Bourgeault, I; Saul, J

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Emerald
• Journal: Journal of Health Organization and Management
• Volume: 32
• Issue: 1
• Pages: 9-24
• Publication date: 2018-01-02
• Acceptance date: 2017-11-08
• DOI: 10.1108/JHOM-06-2017-0129
• EISSN: 1758-7247
• ISSN: 1477-7266
• Keywords: systems thinking; global alliance; inter-organizational networks; human resources for health