Development through Fractals: Strategic and Operational Cycles in Healthcare Collaborations

Abstract

This paper addresses the development of healthcare collaborations by examining how inter-organizational strategic and operational processes unfold and are aligned with each other. Based on Ring and Van de Ven’s (1994) process model of inter-organizational cooperation, we examine the set-up and implementation of a Dutch healthcare network, and identify the following main insights. First, the network’s inter-organizational strategic and operational processes consisted of recursive and intertwined cycles of negotiation, commitment, and execution. Second, these intertwined cycles, while broadly informed by each other’s commitments, nevertheless appeared to largely develop in parallel. Finally, the partners’ strategic interests and operational activities were tacitly aligned through the involvement of middle managers in both the strategic and the operational processes. Our findings help to further open the black box of how inter-organizational healthcare collaboration develop, with a series of practical implications for healthcare managers.