Healthcare network governance and accountability shaped by social capital

Drawing on concepts from social capital theory, we examine how governance of a mandated public sector hospital network is implemented and the challenges the implementation poses for accountability and governance. Adopting a whole network perspective, we conduct a case study of one mandated hospital network in Ireland. Based on fifty-five semi-structured interviews, we demonstrate the co-existence of two different governance models: (1) the espoused officially sanctioned Network Administrative Organisation governance model, and (2) the actual governance model in operation which was more similar to a lead-organisation model. We provide theoretical insight into how complex governance arrangements emerge through the management of network tensions to prioritise particular poles of the tensions. Further, we analyse why the espoused NAO model was unable to respond to the accountability and governance challenges that arose. We identify how pre-existing bonding social capital between the “centralised network broker” (the Network Administrative Organisation) and the hub hospital limited the potential for social capital to expand from a private to a public good that could benefit the network as a whole. Our findings illustrate accountability and governance challenges in a mandated network and provide important insights for hospital managers and policy-makers by bringing to the fore the “dark side” of social capital and its ability to fragment broader collectivities, such as networks, in the name of local, particularistic identities. We draw attention to the importance of monitoring social capital development during network governance implementation and to how opposing poles of network tensions are managed.HIGHLIGHTS Different governance models can co-exist within mandated networks.These complex governance arrangements emerge through the management of network tensions to prioritise particular poles of the tensions.Pre-existing bonding social capital limits the expansion of social capital from a private to a public good within the network.