The Organisational Infrastructure of a Canadian Rural Health Network: A Four-Year Longitudinal Survey Study

Background: Formal networks are increasingly being used as a strategy to address complex health system issues. This study aimed to understand the organisational performance of a novel network, the Rural Surgical and Obstetrical Networks (RSON) in the Canadian province of British Columbia, as it developed and grew over four years. Methods: Between 2019 and 2022, we administrated an annual 37-item survey on network organisational aspects with RSON leaders. We calculated the percentage of favourable ratings (four or five rating out of five) for each survey item and used a two-tailed Wilcoxon Mann-Whitney rank sum test to compare ratings over time. Key themes in respondent comments were described narratively. Results: Over four years, we distributed 114 survey invitations to RSON leaders and received 77 responses. From 2019 to 2022, 24 out of 37 survey items (65%) had a statistically significant increase in ratings. Ratings and comments indicated that RSON could have improved its function by (a) including more peripheral network members in decision-making and (b) formalising structures and processes for some network areas. Findings also indicate the presence of three network tensions within RSON: inclusiveness versus efficiency, stability versus flexibility, and network operations versus health system operations. Conclusion: Study findings validate and build on existing network theories and provide practical learnings for other jurisdictions interested in implementing a network like RSON. Among the tensions identified within RSON, the network operations versus health system operations tension, specific to a healthcare delivery setting, has not been well described previously.