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Introduction
“Collaborative governance” is seen as a relatively new governance concept applied in several policy fields including healthcare. Although all governance is, to some extent, collaborative, the notion of “collaborative governance” refers to governance arrangements that pro-actively include a broad range of stakeholders (both public and private) in collective decision-making processes to reach policy objectives (Emerson and Nabatchi, 2015a; Ansell and Gash, 2008; Sørensen and Torfing, 2007). Collaborative governance may offer new and alternative routes for interaction between actors beyond command and control (Leicht, 2016), through which traditional (i.e. hierarchical and top–down) and managerial (i.e. control and performance based) forms of governance usually operate (Bryson et al., 2014; Pollitt and Bouckaert, 2011). Instead, collaborative governance builds on mutual interdependencies, shared responsibilities and co-production of goals and strategies by partners in a network (Ulibarri and Scott, 2017). Yet, the success of collaborative governance approaches greatly depends on a system’s capacity to align different stakes, responsibilities and resources at multiple levels. Such capacity is not easy to build in the healthcare sector, which is studied here, as collaborations beyond boundaries of medical disciplines, between managers and health professionals and different levels of authority (Carey and Friel, 2015; Harvey and Kitson, 2015; Seddon, 2013) are uncommon. Furthermore, the healthcare sector is known for particularly strong stakeholder and interest representation through powerful occupational groups, such as medical associations and academic societies (Freidson, 2001), notoriously resistant to policy and managerial change (Baker and Denis, 2011).
Collaborations in various healthcare settings, whether intra- or inter-organizational (e.g. interprofessional collaboration, multidisciplinary teamwork, academic or clinical partnerships) and within or beyond the boundaries of health service delivery (i.e. with patients and their families or with communities, associations, businesses, authorities and others) are recognized to produce improved health policy outcomes (D’Amour et al., 2009). For example, better alignment of health services may reduce unnecessary treatment and make it easier to shift patients from costly types of care (e.g. acute and specialized hospital care) to less costly ones (e.g. ambulatory and preventive care) (Schepman et al., 2018), thereby contributing to the sustainability and affordability of care. For that reason, policymakers, funders and healthcare professionals worldwide increasingly foster collaborative partnership (Kaiser et al., 2018). Both quantitative and qualitative research demonstrates a variety of...