Self-evaluation of territorial health networks: seeking legitimacy from multiple stakeholders

Abstract

The development of public health policies in connection with the changes in the demographic and economic environment led to profound changes in the definition of health networks and their tasks within their scope of action and in their funding. To ensure their existence, they must manage their legitimacy by reconciling the expectations of multiple stakeholders. By mobilizing the new institutional theory, this article examines the organization and activities of a Territorial Health Network (THN) testing a self-assessment model proposed by the French National Authority for Health (NAH). The comparison between the structure and the reference activities provided by the model NAH and those implemented by the network on its territory of action highlights the existence of invisible skilled activities. These invisible activities don’t allow the actors to demonstrate their legitimacy under NAH model. The problem is that the quest for legitimacy with multiple stakeholders takes the actors away from the NAH model and does not allow them isomorphism which provides and sustains funding. Legitimizing THN supposes that the various stakeholders prioritize their needs and elaborate a model of self-assessment able to integrate multiple sources of legitimacy.