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Always look on the bright side of life? Managing tensions inherent to collaborations – A tensions-based view on networks of integrated care "


Anna-Sophia Bilgeri

Imp-hsg University Of St.gallen, CH
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Introduction and theory: 

Networks of integrated care are thriving around the world – in Switzerland alone we currently see around 172 initiatives of integrated care. They are becoming more prevalent since they offer innovative health and social care models that address essential challenges posed by an ageing population and the associated spread of chronic diseases. In the diverse setting of integrated care, inter-organizational networks constitute complex social systems which gain in popularity. Surprisingly, integrated care networks are often prematurely presented as balanced, flexible, cooperative or efficient. Notwithstanding their potential to sustain access to affordable high-quality care or reorganize service delivery, we can also observe numerous tensions in the development of integrated care networks. In our study, we therefore shed light on the evolvement and dynamics of integrated care networks. Our focus lies on managing multiple tensions and contradictions over time as a key challenge in developing integrated care.

Methods and results:

We conducted a long-term qualitative single case study that adopts a process view on networks to understand how managerial agency produces multiple tensions and is at the same time enabled and constrained by these tensions. The focus lies on how ordinary activities unfold over time as web of practices. At the centre of this case lies an aspiring, urban healthcare network in the western part of Switzerland. This empirical case is particularly revealing since it illustrates a network with dynamic practices and a variety of inter-organizational tensions. The process approach thereby offers a particularly promising lens to study dynamic and complex social phenomena in integrated care networks. Data collection included 19 semi-structured interviews, 3 shadowing days, and 37 archival records. Data analysis followed an abductive approach. After a first round of inductive coding, we revealed how managerial practices produce and are reproduced by multilevel tensions, generating the emergence and change of the system. In a second coding round, we consulted additional literature to develop richer theoretical explanations on tensions in inter-organisational relations. Inspired by the tension-based lens on networks, we re-coded our empirical data, focusing on inter-organizational practices on managing emerging tensions inherent to networks of integrated care. Our study proposes a theoretical model of how integrated care network evolve in the interplay between management and inter-organizational tensions.

Discussions and conclusion:

A tensions-based view on integrated care networks shifts the focus on managerial practices as a reflective coordination of tensions and simultaneously as the driving force of joint value creation and network dynamics within regional health and social care networks. 

Lessons learned:

Our study helps us to (re)think the development of integrated care networks as systemic, reciprocal, processual and dialectical systems, which require specific managerial practices.

Limitations and future research:

This study is limited to a single case in Switzerland. Further research is required to explore managerial approaches to deal with network tensions in more detail, to understand their characteristics and interrelationships and to explore to what extent health systems are constituted by similar or different inter-organizational practices. 

How to Cite: Bilgeri A-S. Always look on the bright side of life? Managing tensions inherent to collaborations – A tensions-based view on networks of integrated care \". International Journal of Integrated Care. 2021;21(S1):132. DOI:
Published on 01 Sep 2021.


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