Collective action in interorganizational networks

Abstract

Mental Health service provision organizations have strong professional norms of cooperation, which exert pressures on organizational actors to integrate and coordinate services to better, serve clients. Pressures to integrate services sometimes run counter to the funding mechanisms employed in delivery systems. This is especially true for managed care. This study examined whether integration increased or decreased as a result of the introduction of risk-based managed care in one community. Data were collected at two points in time, 1996 and 1999, in order to assess changes in services integration over time. Survey instruments and field interviews were employed to collect the relevant data. Standard network analysis techniques and simple content analysis were used for the analysis. The theoretical portion of this dissertation sought to determine which set of literature better described what occurred in a normatively cooperative network with competitive, managed care incentives. I reviewed literature in organization theory, common pool resources, and mental health to support a cooperative view of mental healthcare delivery, and reviewed principal-agent theory and managed care to support a non-cooperative view of mental healthcare delivery. I found that despite the competitive incentives introduced into the mental health delivery network, integration increased over a three-year period. Integration was measured using network measures such as density, degree centrality, cliques, core provider analysis, and blockmodels. The network findings were further supported by the qualitative analysis performed on the interview data. The latter part of the dissertation develops a model that explains collective action in interorganizational networks. It draws upon the organizational theory literature by describing the determinants necessary for network formation and using the concepts of communication, norms, time, and context. The common pool resource literature contributes a diagnosis stage to the model that assists in explaining how networks change and develop desirable characteristics over time, while supplementing the OT literature's perspective on communication, context, and time. I also suggest ways in which this dissertation contributes to practice, focusing on the systems design of mental health delivery systems.