Editorial: Evolving health landscapes: the role of network governance in integrated care

Abstract

In this Editorial, network governance is understood as a broad umbrella concept rather than a single institutional model. It refers to arrangements in which interdependent actors coordinate across organizational and sectoral boundaries through negotiation, trust, and shared rules, rather than through hierarchy or markets alone. The contributions to this collection range from collaborative tables set up at the request of a provincial ministry and regional networks sustained by insurer contracts to publicprivate co-creation of digital care and a clearly hierarchical medical alliance. Network governance rarely appears in pure form, and its mix with hierarchy, contracts, and incentives is part of what the collection examines.The articles share one insight. Integrated care does not emerge from professional goodwill or organizational innovation alone; it depends on political, institutional, and relational conditions that make cooperation possible across sectors, professions, and levels of government. Hence the central argument of this Editorial: integrated care is a governance process that redistributes authority, resources, voice, and accountability. Network governance is therefore promising but ambivalent. It can foster coordination and participation, and it can also expose power asymmetries, financial fragility, and professional resistance.Liu and Tsasis (2026) look at the Sub-Region Collaborative Tables that Ontario's Ministry of Health asked health regions to create. Surveys and interviews with health leaders reveal poor communication and few shared goals across sectors, especially with primary care and French-language and Indigenous communities. The authors identify three primers for integration: complexity leadership; trust and mutual respect, and readiness to collaborate. Their findings show the limits of mandated collaboration, since a ministerial directive can bring actors to the table but cannot create trust by itself. Wright et al. (2026) review the main collaborative governance frameworks and argue that they take for granted a shared purpose, resources, and legitimacy, which frontline teams seldom have when they first reach out to partners. Collaboration is better understood as a continuum from outreach to consultation and involvement. Because collaborative governance grew out of democratic theory, the point is also political, and the authors call for tools that help frontline actors deal with power imbalances, particularly when governments and hospitals are involved. 2026) compare seven regional health networks in Germany. Networks develop where founders are committed, members see tangible benefits, performance can be demonstrated, and institutional partners and shared care pathways are in place. Fragmented financing, limited acceptance, and selective contracting pull the other way. For the authors, integrated care is as much a political challenge as an implementation one, and the survival of these networks depends on reforms that break down financing silos, let tasks move from physicians to other professions, and widen the legitimacy of network governance.Teig and Gjerstad (2026) study how municipalities, care professionals, and technology suppliers co-create welfare technology in Norwegian primary care. Far from being a neutral participatory method, co-creation ends up deciding who plays which role and whose expertise counts. Suppliers gain discursive power by framing technology as inevitable, smaller municipalities come to depend on them, and it becomes harder to say who is accountable. Drawing on care ethics, the authors describe co-creation as "politics by other means". 2026), the only case from outside Europe and North America, evaluate an alliance between a tertiary teaching hospital and a county hospital in Jiangsu. Over four years, embedded leadership, a joint fund, surgical training, and DRG-based cost control were associated with more complex surgery, fewer outward referrals, and less reliance on drug revenue. Integration here was promoted by the state and organized through hierarchy, with the tertiary partner's vice-president appointed as the county hospital's executive director. Local capacity improved, but the arrangement leaves the county hospital dependent on its partner.Read together, the contributions converge on six governance dimensions. Coordination runs through all of them, whether through relational coordination in Ontario, a continuum of collaboration, shared care pathways in Germany, boundary-spanning roles in Norway, or embedded leadership in China. Funding brings fragility as well as stability: German networks are caught in what Richter et al. call a "project trap", whereas the Chinese alliance relies on a jointly governed fund. Professional participation drives integration but also provokes resistance, as German physicians fear losing clinical autonomy and frontline staff remain largely outside formal governance arenas. Power is redistributed rather than neutralized, from physicians to nurses, from municipalities to technology vendors, and from a county hospital to its tertiary partner. Legitimacy rests on performance and public trust, yet it is contested when technical expertise is privileged over care knowledge. Accountability becomes diffuse when public and private actors share responsibilities, and more concentrated, though dependent on the partner institution, when authority is embedded hierarchically. In all six dimensions, what promotes integration can also create dependence, exclusion, or blurred responsibility. Integrated care, as these contributions make clear, is a governance process through which authority, resources, voice, and accountability are redistributed. Any strategy for integration therefore involves political choices about who decides, who takes part, who pays, who coordinates, and who benefits, whether or not these choices are acknowledged. Only by making them explicit can integration be legitimate and fair, and not merely effective. With conceptual work, reviews, and empirical studies from Canada, Germany, Norway, and China, this collection should help researchers, policymakers, and practitioners understand how more integrated, equitable, and responsive health systems are built politically.