Working Toward Network Governance: Local Actors’ Strategies for Navigating Tensions in Localized Health Care Governance

Although network governance has become increasingly popular in both research and practice, its anticipated benefits do not always materialize. Although literature on network governance acknowledges the challenges that result from its introduction, scholars tend to assume these challenges can be managed and rarely analyze how the different participating actors (strategically) react to the tensions surrounding its establishment. As such, the process of how “networking” actors establish, maintain, and negotiate a network remains understudied. In light of these shortcomings, this article zooms in on how actors, in their collaboration efforts with network partners, navigate the tensions between (a) their discretionary space and the parameters set by a central policymaker, and (b) their pursuit of both integration and differentiation. This ethnographic case analysis contributes by, first, revealing how local actors demonstrate agency in maneuvering between these tensions in everyday practice by adopting three strategies—that is, overwhelmed deflection, situational segmentation, and strategic reappropriation—and, second, by revealing how these tensions interact and subsequently affect the implementation of policies in networks.