Integrating Health in All Policies at the Local Level: Using Network Governance to Create ‘Virtual Reorganization by Design’

  • Morton Warner
  • Nicholas Gould


The thesis of this chapter is that the Health in All Policy innovation process is only complete when national intentions have linked up with, and made a change to, ‘practice’ at the local level. Much is known about the way bureaucratic hierarchies attempt, but often fail, to make this happen, but much less so in relation to networks. For the latter, evidence is presented showing their superiority when policies are complex, requiring cross organizational action, and when the potential effort directed to their achievement is fragmented.

In the case of HiAP both situations apply. However, in the dialog between 26 of 32 countries meeting in Finland in 2006 to consider obstacles and driving forces in relation to HiAP, it is remarkable that no consideration is given to the possibility that the very nature of organizations, and what they represent to those who work in them, might be a root cause of the many years of relative failure to bring about multisectoral, interorganizational action.

Directed specifically toward improvement of interorganizational relationships, the chapter focuses on arrangements that can be put in place to overcome barriers to integrative action. These may be structural, procedural, financial, professional, or relate to status and legitimacy.

Ultimately, the aim is to achieve virtual reorganization, with the design of bringing together interorganizational effort to achieve health and social gain targets. This is Policy Innovation Number 1.

The journey to this end involves an understanding of what will:
  • bring a diverse range of organizations to the table to form networks – using resources better, gaining wider skills, sharing risk and uncertainty, adaptive efficiencies, and legal or regulatory demands, and

  • the crucial elements involved in network development if success is to be assured – the right choice of network type, relating to complexity of the problem, the specialist knowledge required, size, etc; an understanding of the organizational cultures of members; communication arrangements; and good governance.

This is Policy Innovation Number 2.

The chapter also introduces the ‘neutral white space’ concept – a zone between participating organizations where they can meet in an unfettered, less guarded way. Coordination of activity is key; and a particular role is described which involves ‘attracting’, ‘guiding,’ and brokering white space and virtual reorganizations’ activities, that is working with networks in the space and assisting in mainstreaming the results of their creative thinking. This is Policy Innovation Number 3.

The evidential base which enabled the above approach to be developed was tested in an extensive 4-year action research project in South Wales, UK. This is reported here in case study form as a self-standing item at the end of the chapter. Policies which might provide a better quality of life and health for older people were developed through coordinated networks concerned with crime, transport, income and medication, and implemented by the partner organizations working in a virtually reorganized way.


Network Activity Community Pharmacist Policy Innovation Network Development Virtual Organization 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Welsh Institute for Health and Social Care, Glyntaff CampusUniversity of GlamorganPontypridd

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