Service networks : a study of collaborative working in primary healthcare

Abstract

The shift in focus from dyadic interactions to many-to-many interactions is a crucial aspect of Service Dominant Logic (SDL) in that it places great emphasis on collaborative processes engaging multiple actors. Collaborative working is being increasingly championed in the healthcare sector as the move from hierarchical to network operational structures continues apace. The General Practitioner (GP) federation model exemplifies one service network emergent in this sector. Empirical understanding of these service networks is absent in extant literature. The aim of the study is to critically analyse, through the lens of SDL, the GP federation service network emerging within England’s primary healthcare sector. A multi-methods qualitative research approach (participant observations, semi-structured interviews, document analysis and netnographic data) is employed to examine four distinct GP federations (service networks) operating in England. Literature, and empirical data, explore the effectiveness of SDL in terms of enhancing understanding of value co-creation in service networks. The transferability of established principles of business and social networks to service networks. How different structural elements and characteristics of service networks impact their effectiveness of working at scale. And how examining service networks from a service systems perspective that incorporates micro (individual GP practice), meso (the structural operationalisation of the federation) and macro (wider ecosystem including NHS and Government) levels uncover previously unrecognised opportunities and barriers to effective healthcare performance. Findings contribute to our understanding of SDL, illustrating the value of SDL as a lens for examining the intricacies of a complex service network. They demonstrate how perceived value changes over time and is a function of changes at macro, meso and micro levels. They add agility and flexibility to characteristics of effective service networks. They argue that not all models of collaborative working fully realise the commonly proffered benefits attached to this model. A new collaborative network model is proposed which includes sharing risk as a hitherto unrecognised potential benefit of network working. Theoretical contributions include a retesting of SDL, an application of existing network principles in a novel way, an extension to knowledge linked to collaborative working at scale and a unique application of service concepts and models to examine GP federations. Multiple contributions to the practical implications of working at scale emerge, collectively of importance to future healthcare policy.