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Committed to network governance: strategies for local participants to deal with tensions in local medical governance

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Abstract: Although network governance is becoming more and more popular in research and practice, its expected benefits can not always be realized. Although the literature on network governance recognizes the challenges brought by the introduction of network governance, scholars tend to believe that these challenges can be managed, and rarely analyze how different participants (strategically) deal with the tensions surrounding network governance. Therefore, the process of how "network " participants establish, maintain and negotiate the network remains to be studied. In view of these shortcomings, this paper will focus on how participants deal with (a) the tension between their discretionary space and the parameters set by central decision-makers, and (b) their pursuitf 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.

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