Voices from the frontline: Network participation and local support for national policy reforms

Abstract

In this article, I explore the determinants of frontline service organizations' support for and implementation of social policy reforms in the context of the US national health care reform. Ascribing to theories of inter-organizational collaboration, I argue that local service organizations, as the frontline agents of policy changes, develop their policy preferences and implementation activities in accordance with the collaborative networks, in which they situated. Network participation reduces uncertainty about the new political environment and motivates organizations to join the reform coalition. Using a sample of near 1,000 American hospitals, I offer the first systematic study of hospital chief administrators' support for the Patient Protection and Affordable Care Act (ACA), as well as their hospitals' preparation for and compliance with the ACA. I find hospital managers who actively engage in external networking activities are more likely to support increasing government role in providing health care insurance. Hospitals that actively participate in service collaboration are also more likely to comply with the ACA. These findings challenge the conventional view of frontline service organizations that they passively adapt to political changes. This article also adds to the network collaboration literature by showing that networking activities not only affect organizational performance, but also shape organizations' preferences about government solutions to social problems.