Going in circles? - Identifying the dissemination process of healthcare networks within their member organizations

Purpose-oriented networks are the dominant organizational model for collaboratively addressing complex healthcare challenges. However, their impact on health outcomes remains limited, because organizations rarely adapt their practices based on network-level decisions. Using an in-depth multiple case study of three multi-hospital networks, we therefore developed a process model to understand the dissemination process from the network level to the operational level. The study utilized 24 hours of network meeting observations, 241 pages of document analysis, and 39 semi-structured interviews with representatives attending network meetings and operational-level constituents. We identified a cyclical five-component dissemination process: achievement of transferrable output, brokerage activities of representatives, internal transfer, adoption within member organizations, and organizational input in the network. Three overarching inhibiting factors-lack of time, lack of commitment, and constituency misalignment-influence each component. This model, rooted in network theory and implementation science, explains why many networks fail. Furthermore, it offers a framework for network managers to navigate each component systematically, addressing threats and barriers to enhance the dissemination process and network success.