This is the century of the system of the network with a network being a set of organisations and individuals that deliver the objectives of the system.   Military thinking distinguishes strategic and operational command with the strategy, the system’s objectives, being set once, and local operational commanders, the networks, being asked to deliver the objectives taking into account local history, geography and politics.

Perhaps the best description of the relationship between networks and the bureaucratic structure of the Health Service is that given by Nonaka and Takeuchi in their 1995 book The Knowledge Creating Company.

“A business organisation should have a nonhierarchical, self-organizing structure  working in tandem with its hierarchical formal structure…..As business organisations grow in scale and complexity they should simultaneously maximise both corporate level efficiency and local flexibility…the most appropriate name is the ‘hypertext’ organisation” Ikujiro Nonaka and Hirotaka Takeuch

They describe how networks float besides their bureaucracy, respecting the bureaucratic rules when it comes to linear tasks such as the fair and open employment of staff or the uncorrupt management of money, but adapting, developing and relating to one another in different ways  to take into account local issues and circumstances and this can be described as a picture:







There are of course a number of different population levels of each network that need to develop.  One could be at a large population, a country, or a region or a state for example.  A second would be in a health community, for example a general hospital working with all the primary care teams that relate to it and involving the local mental health and community services, and a third would be a network for primary and community care for a smaller population. In England these are called Integrated Care Systems, collaborative partnerships and primary care networks respectively.

The network is a knowledge organisation and its authority comes from knowledge, sometimes called sapiental authority, and it is clear that networks, that require collaborative culture will be the dominant organisational arrangement for the decade to come and our system development always includes network development and the need for a collaborative culture.