Matthias Mitterlechner

Reconstructing Leadership in Networks as a Reflexive Practice

This chapter provides important conceptual foundations for reconstructing leadership in networks from a practice-theoretical perspective. It introduces basic principles of practice and structuration theory, offers practice-theoretical definitions of inter-organizational networks and leadership, and explores the role and definition of reflexivity in network leadership.

A Practice-Theoretical Model of Reflexive Leadership in Networks

This chapter offers a novel practice-theoretical model of reflexive leadership in inter-organizational networks. The model builds on practice-theoretical conceptions of networks, leadership, and reflexivity. At its core, it proposes that leadership action and structure are in a recursive relationship, assuming a duality rather than a dualism. As such, leading in networks cannot be attributed to the behaviors, traits, and activities of individual “leaders”, nor to certain structural features of a network. Rather, it conceives of leading in networks as a reflexive practice through which actors collectively question traditional inter-organizational practices and explore new ways of coordinating their activities across organizational boundaries.

Case Study II: Urban

This chapter describes the practice-theoretical model of reflexive leadership in networks by means of the case study “Urban”. Urban is a healthcare network in a large urban Swiss region, founded as an association on November 10, 2009. The case study shows how Urban’s leadership constellation attempted to improve the healthcare delivery in the city by coordinating care activities among different outpatient and inpatient service providers. At the end of the observation period in 2014, the outcome was, however, sobering for many network member organizations and stakeholders at the organization and organizational field level.

Case Study I: Peripheral

This chapter describes the practice-theoretical model of reflexive leadership in networks by means of the case study “Peripheral”. Peripheral is a healthcare network in a rural Swiss region, initiated on January 1, 2007. The chapter illustrates how a regional leadership constellation formed a well-integrated healthcare network between 2003 and 2013. Over these years, the leadership constellation successfully coordinated initially fragmented back-office and patient-centered activities among a regional hospital, an outpatient care organization, a thermal spa, and additional regional social services organizations. At the end of the observation period in 2013, the network counted as a pioneering integrated care network in Switzerland.

Theoretical Foundations of Leadership in Networks

Research on leadership in inter-organizational networks has remained scant. This chapter reviews the few studies that exist on the topic, deconstructs important basic assumptions, and sheds light on their affordances and limitations. To deal with their limitations, it argues for a reconstruction of leadership in networks from a practice-theoretical perspective, which is able to capture the dynamics of network leadership by conceptualizing leadership action and structure as recursively related over time.

The Need for Reflexive Leadership in Inter-Organizational Networks

In view of the growing importance of network-based collaboration in both the public sector and private sector, it is quite surprising how little we know about how network member organizations actually practice leadership in the networks in which they are involved. This chapter lays the groundwork for the book, introducing the research question and key research issues in the field, highlighting the relevance of reflexive network leadership for research and managerial practice, situating the book in the recent practice-turn in the social sciences, providing an outlook on the two empirical case studies informing theory building, and summarizing key theoretical and practical implications.

Preserving Care Delivery in Hard-to-Serve Regions: A Case Study of a Population Health System in the Swiss Lower Engadin

Introduction: Many countries report difficulties in preserving access to care in rural areas. This paper examines how hard-to-serve regions sustain care provision by transforming service delivery into population health systems. Theory and methods: The paper builds on theory on care delivery in hard-to-serve regions. It presents a qualitative case study from the Lower Engadin, a rural high mountain valley in the Swiss Alps. Data sources include semi-structured interviews, participant observations, and documents. Data are analysed using recent conceptual research on population health systems. Results: The case study illustrates how politicians and providers in the Lower Engadin resolved a care crisis and preserved access to care by forming a population health system. The system is organised around the Healthcare Centre Lower Engadin. Citizen-centred interventions target an aging population and include health promotion and prevention programs as well as case management based on an ambulatory-before-inpatient care strategy. Conclusion: Hard-to-serve regions like the Lower Engadin preserve access to care by reorganising service delivery towards population health systems. The paper contributes to research on population health systems and care provision in rural areas.