Governance, management control and social capital in mandated hospital networks

This study examines how mandated networks are governed and controlled by management. Mandated networks are the emergent product of reform implementation in the public sector in the expectation of greater efficiency and effectiveness of service provision. This study was conducted as a single, longitudinal case study in a mandated hospital network in Ireland, adopting a qualitative research approach. In-depth semi-structured interviews were conducted at senior managerial and clinical level in the organisation over a three-year period. The structural, relational and cognitive social capital framework proposed by Nahapiet and Ghoshal (1998) is used as the method theory to analyse and interpret the findings. Contributions to network governance research, management control research and social capital theory are made. This study reveals how the network governance model intended as a Network Administrative Organization (NAO) morphed into a hybrid governance model with the central hub hospital in the network assuming a leading role in clinical service and clinical practice development due to disproportionate, although unintended, influence possibilities for this network member. Hybridization of network governance occurred by reason of pre-existing social capital between the intended NAO and the central hub hospital in the network that was maintained and strengthened after network formation. The hub hospital came to strongly influence the development of inter-organizational management control mechanisms (MCMs), most of which evolved from local, intra-organizational MCMs, at the hub hospital and were stretched and intended to become interorganizational network controls to be adopted by all hospitals in the network. Overall, the hybrid governance model that emerged in this network failed in its efforts to embed members in the network and generated a sense of exclusion and disenfranchisement among non-hub network members. Social capital developed in this network was weak and, therefore, insufficient to facilitate successful collective action, a core objective of mandated networks under the post-NPM reform efforts of ‘working together’.2026-10-1