Abstract
BACKGROUND: Complex problems in healthcare (fragmentation, specialization, and increased costs) are often addressed by implementing collaborative interorganizational networks. Theoretical models prescribe organizational practices that should ensure the effectiveness of these networks. However, these models are mostly aimed at organizing networks to achieve optimal effectiveness. One of the mechanisms increasing effectiveness, is the involvement of network members. We argue that even though network involvement may be high, there are mechanisms at play that decrease the member's perceived network goal attainment, resulting in dissatisfied and dissociated members. One of these mechanisms is the comparison of input and output versus the input and output of other members; while the other is the pursuit of organizational goals by network membership. In combination with each other, these may lead to low perceived network goal attainment. METHODS: We apply a mixed method study in a local primary care network (PCN) in the Netherlands. We collect and analyse two types of data: (1) interviews, analysed using thematic analysis, and (2) surveys, analysed using crisp-set qualitative comparative analysis (QCA). RESULTS: We found three different pathways to low perceived network goal attainment. Members that are highly involved with the network, can still feel dissatisfied with the network's goal attainment if they engage in social comparison or if they pursue organizational goals rather than network goals by network membership. We called these pathways over-achieving, and frontrunning. The third pathway, freeriding, describes members that are not very much involved in the network, but pursue organizational goals rather than network goals, and are also dissatisfied about the network's goal attainment. CONCLUSION: Network member involvement positively affects perceived network goal attainment. We argue however, that even high network involvement can result in low perceived network goal attainment. Member's comparison of each other's input and output, as well as the pursuit of organizational goals, result in low perceived goal attainment even if members' involvement is high. Future research aimed at network level effectiveness should take member level characteristics and sociodynamic factors into account.