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Abstract :
[en] The contemporary Belgian health policies (mental health, chronic diseases, rare disease...) constitute a real challenge in terms of governance, in the sense that they mobilise interdisciplinary networks of actors. Indeed, Belgian health policy plans in different health sub-sectors request cross-sectoral or cross-organisational collaborations (Clavier & Gagnon, 2013; Crosby & Bryson, 2010) as an answer to complex societal problems (Daviter, 2017). In this context, coordinators emerge as intermediary actors entrusted with a political mandate consisting in connecting different levels of action, sectors and organisations. With this communication we aim to study the coordinators’ place in the forensic mental health governance structure.
Three different methods of data collection have been combined. It includes document analysis (i.e. policy plans, coordinators job descriptions), more than sixty semi-structured interviews with key stakeholders (policy-makers, coordinators and network professionals) and fifteen observations of meetings (federal coordination meeting with political authorities and local network meetings organised by coordinators). We argue that this triangulation of data collection methods allowed us to comprehensively understand the coordinators’ place in the governance structure as well as their role in the policy processes. The collected data were analysed in Nvivo thanks to a system of coding both developed inductively as well as deducted from the literature review. This abductive methodology helped us to constantly confront the field reality with the scientific literature.
Thanks to our methodology, we could follow the implementation and construction processes of the forensic mental health policy plan since 2016, both at the federal (top-down practices) and local levels (bottom-up practices).
Our empirical material has showed that coordinators are key actors of the forensic mental health sector governance structure. By being at the intersection of several sectors, institutions and persons, coordinators indirectly enhance communication between previously separated actors (i.e. from justice, health and welfare sectors). First, coordinators constitute a bridge between the justice and health sectors and, therefore, allow the articulation of those different stakeholders at different levels of action (i.e. between justice and health organisations). The arrival of those professionals has strongly reinforced the cross-sectoral governance of the sector. Second, by being situated in between the federal and local levels, coordinators also ensure the vertical integration of policymakers’ and professionals’ visions, by reinforcing both top-down and bottom-up practices. This contribute to strengthening the vertical line of governance. Finally, coordinators also enhance the horizontal integration of the different network partners’ ideas, information and concerns between one network’s partners, reinforcing the network governance.
Contemporary health policies ask for new modes of governance, promoting collaborative governance (Kislov et al., 2017) and setting up networks to enhance collaborations (Buttard, 2008). More specifically, mandated networks show a special need for mixed governance styles in order to achieve a higher level of coordination when facing a mandated network (Rodriguez et al., 2007).
As we saw with the forensic mental health sector, coordinators allow to overcome certain barriers in terms of governance and enhance at the same time different styles of governance (i.e. vertical and horizontal). Thanks to their intermediate position coordinators support the development of an effective collaborative governance including a diversity of stakeholders.
However, the research showed that the coordinators’ style of leadership (transformational, integrative, and authoritative) substantially defines the policy governance structure. Therefore, we would like to raise the question of the training and selection of those emergent intermediary professionals.
