Networks for health-care reform

A recent front-page Washington Post article, "Point men for a revolution: Can the Marines survive a shift from hierarchies to networks?" gave perhaps the first visible sign of a major transformation in process. Specifically, some who study organizations believe that networks are slowly but surely becoming the expected central organizational form of the 21st century global society. In other words, organizations such as corporations or the military are reconfiguring themselves to rely less on hierarchical relationships and bureaucratic structures, and more on networks within and between organizations. This transformation, if occurring, likely will have a significant impact on our health-care system delivery.

From clans to hierarchies

To understand networks as an organizational form, or as an organizing principle, it helps to understand preceding forms of organization. Historically, the first major form to define the organization of societies was the tribe or clan. Its key organizing principle was kinship: People organized themselves almost exclusively based on familial relationships. While kinship remains the central organizing principle in some parts of the world, our society has moved far beyond this developmental stage.

The next organizational form to emerge was the hierarchical institution where, according to David Ronfeldt, a senior social scientist at RAND, "Collective identity was no longer represented in the figure of a common ancestor, but in that of a common ruler." Government, military branches and traditional corporate organizations are good examples of hierarchical organizations. They provide considerable structure, order and predictability. Unfortunately, they are also rigid, individually constraining and relatively inadequate at processing complex information. These limitations of hierarchical organizations prompted development of the competitive "market" as the next organizational form.

According to Ronfeldt, the market is defined by open competition among private interests that supposedly behave freely and fairly. The market creates an environment where people are free to act on personal interests, private motives and individual rights. It is the practical opposite of constrained hierarchies. But whatever its strengths, a market organizational system also has significant limitations, not the least of which is its inability to deal adequately with health-care services as I have previously described here. A market form of organization perpetuates exploitation of others in the service of self-interest and helps maintain social inequities by facilitating "haves" and "have nots." The market operates by a principle of winners and losers and, notwithstanding antitrust laws against monopolies, the winner takes all.

The rise of the network

Partly in response to limitations of hierarchies and markets, networks as an organizational form and organizing principle are on the rise. The information technology revolution has changed the view of networks as inefficient and slow given the complicated decision-making process necessary for the multiple and distant members to have their say. Faxes, e-mails, listservs and other forms of telecommunications have enabled maximizing the strengths of individual and organizational networks while minimizing the deficiencies. The result is an organizational form considered much better suited to the changing complexities of contemporary society. Networks are more flexible than hierarchies, more invested in the public good than markets and more effective in responding to changing conditions than either hierarchies or markets.

More to the point, many believe the network form of organization is particularly well-suited to address social issues, including health care. The rise of the network form of organization in this country may provide a more receptive arena for accomplishing health-care reform--for correcting problems that result from a market-driven health-care system that values profit above patient care, capital above knowledge and information, competition above reciprocity and cooperation, and immediacy of market demand over concern for future health and well-being. In fact, some believe that a nonprofit, service-oriented "social" or "third" sector is emerging to co-exist with the private and public sectors. Perhaps within this emerging sector it is feasible to accomplish a reformed health-care system in a way not yet possible in either the public or private sectors, nor within the government-based hierarchical organization or the private market organizational form.

Organizations whose purpose is to establish power and authority or to accrue wealth and capital, organizations whose greatest value is order or whose ideal is sovereignty or competition, organizations whose motivating force is self-interest hardly seem well-suited to advancing good health care. On the other hand, network organizations are characterized by their flexibility, interdependence, reciprocity, mutuality, consensus building, cooperation, equity and ability for group empowerment. These are perhaps precisely the qualities crucial for developing an effective health-care system.



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