Understanding the Relational Aspects of Networks of Care for Maternal and Newborn Health: A Revised Operational Framework

ObjectiveWe investigated the relational aspects of the "Networks of Care" (NOC) approach to better define their role and highlight their importance. These relational aspects distinguish NOC from other health system strengthening approaches that aim to enhance the quality of MNH care. NOCs include functional and relational aspects, as defined in the WHO NOC for MNH framework, and offer a promising strategy for enhancing maternal and newborn health (MNH) by strengthening care coordination at an operational level. MethodsWe conducted a cross-disciplinary (healthcare, business, military, aviation, education) scoping review of 90 papers and consulted with key stakeholders to identify and synthesize insights about relational aspects and the associated barriers and facilitators for implementation. We then used the literature review findings and stakeholder feedback to define the relational aspects and revise the Networks of Care Operational framework. ResultsThe revised framework highlights teamwork with its attributes--trust, mutual respect, shared goals, shared values, and psychological safety and behaviors - leadership, shared decision making, situation monitoring and communication. Organizational enablers underlie a NOC to mitigate barriers and strengthen facilitators to teamwork, which include conflict management, complexity of targets, systemic challenges, social ties, formalization of NOC, and roles like boundary spanners. The study identified relational coordination theory as the basis for refining the NOC operational framework. ConclusionThe resulting framework centers relational coordination including teamwork supported by organizational enablers, in enhancing care coordination between health workers, system administrators, and other users and non-health actors in the network. By targeting relational elements in intervention design and evaluation, the revised Operational NOC Framework for MNH may be valuable in strengthening NOC effectiveness and driving quality improvements leading to improved MNH outcomes, and resilient health systems.