The Organisational Infrastructure of a Canadian Rural Health Network: A Four‐Year Longitudinal Survey Study

Background Formal networks are increasingly being used as a strategy to address complex health system issues. This study aimed to understand the organisational performance of a novel network, the Rural Surgical and Obstetrical Networks (RSON) in the Canadian province of British Columbia, as it developed and grew over four years. Methods Between 2019 and 2022, we administrated an annual 37‐item survey on network organisational aspects with RSON leaders. We calculated the percentage of favourable ratings (four or five rating out of five) for each survey item and used a two‐tailed Wilcoxon Mann‐Whitney rank sum test to compare ratings over time. Key themes in respondent comments were described narratively. Results Over four years, we distributed 114 survey invitations to RSON leaders and received 77 responses. From 2019 to 2022, 24 out of 37 survey items (65%) had a statistically significant increase in ratings. Ratings and comments indicated that RSON could have improved its function by (a) including more peripheral network members in decision‐making and (b) formalising structures and processes for some network areas. Findings also indicate the presence of three network tensions within RSON: inclusiveness versus efficiency, stability versus flexibility, and network operations versus health system operations. Conclusion Study findings validate and build on existing network theories and provide practical learnings for other jurisdictions interested in implementing a network like RSON. Among the tensions identified within RSON, the network operations versus health system operations tension, specific to a healthcare delivery setting, has not been well described previously.