From leadership research to district action: Governance configurations of coordination in municipal health promotion: insights from an egocentric network analysis

AI-assisted editorial implementation guide. Proposed district actions are separate from the original authors’ findings and recommendations. Independent peer review of this guide is not asserted.

Read source Search paper agent CC BY 4.0

Evidence and transfer

Education-related source: verify which participants, institutions and outcomes were actually studied before district adoption. Source publication type: research-article. License and identity checks do not establish study quality or causality.

Original authors’ abstract, reproduced under the source license:

Abstract Background Municipal health promotion requires coordination across organizational and sectoral boundaries. Fragmented responsibilities, strong organizational autonomy and limited formal authority can make sustained cross-sectoral coordination challenging. Although research on Health in All Policies and governance capacity has highlighted the organizational conditions necessary for coordination, little is known about how coordination functions are embedded within municipal governance networks. This study examines the structural conditions that shape cross-sectoral coordination in municipal health promotion. Methods Egocentric social network analysis was used to map the professional networks of 14 health professionals working in primary schools and neighborhood settings in a single German municipality. Data were collected through semi-structured interviews combined with structured network elicitation, capturing 662 individuals, their reported interconnections and organizational attributes. Network measures of structural integration, modular differentiation, local cohesion and relational dependency were combined with modularity analysis and ego-removal comparisons. Qualitative interview data contextualized the structural findings and supported the functional interpretation of network modules. Results The networks varied considerably in terms of the structural organization of cross-sectoral coordination. Modularity analysis revealed the following recurring governance domains: education; neighborhoods and social spaces; professional coordination and peer networks. The combined analysis identified three governance configurations. In ego-dependent integration, internally cohesive network areas remained intact after the removal of the ego, but lost connections to other areas. In substitutable coordination, connectivity persisted through alternative individual or collective coordination hubs or relational pathways. In distributed integration, cross-module connectivity was supported by multiple relationships and remained largely intact even without the focal actor. Therefore, network connectedness and local cohesion alone did not determine how strongly coordination depended on individual brokers. Conclusion Municipal coordination capacity depends not only on coordinating professionals and their resources, but also on how brokerage and cross-sectoral relationships are structurally embedded in governance networks. Therefore, strengthening municipal health promotion requires the establishment of adequately resourced and formally supported coordination roles, as well as investment in collective coordination arenas, alternative coordination pathways, and direct cross-sectoral relationships. Recognizing network work as a continuous strategic function can help to create governance structures that are less vulnerable to the loss of individual actors. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-026-15347-8. Keywords: Network governance, Coordination capacity, Boundary spanning, Social network analysis, Municipal health promotion, Intersectoral collaboration

Study methods

This study takes a structural approach to examining municipal governance networks and the conditions under which cross-sector coordination can emerge. Rather than evaluating the outcomes of collaboration, the analysis focuses on the relational structures through which coordination is enabled, constrained or dependent on specific actors.

Limitations

Several limitations of this study should be considered when interpreting the findings. Firstly, the sample size was relatively small, primarily due to the time-consuming nature of data collection. Secondly, the study focused on a specific group of health professionals working in municipal settings in Germany. While this approach yielded in-depth, context-sensitive insights, the findings cannot be generalized to other settings. Thirdly, as the study relied on self-reported interview data, participants may have described their networking practices in a socially desirable way. Fourthly, as participation in the study was voluntary, there is potential for selection bias, with more engaged or reflective professionals potentially being overrepresented and influencing the observed network patterns. This could have led to an overemphasis on collaborative behaviors. Furthermore, the cross-sectional design only captures network structures at a single point in time. This means that it could miss the network’s dynamic evolution due to staff turnover or changing collaborations.

A 90-day district inquiry

Days 1–15 · Appraise. Read the source methods, recruitment, comparator, outcomes and limitations. Record how the study setting differs from your district and which claim the design can support.
Days 16–30 · Design. Select one recurring district decision. Publish the decision owner, evidence requirements, consultation process and appeal route; test the process on a bounded low-risk decision. Agree participation, privacy protections, baseline and stopping rules before starting.
Days 31–60 · Observe. Collect the pre-agreed measures, keep a log of implementation changes and invite confidential voluntary feedback. Preserve existing support for staff and learners.
Days 61–90 · Decide. Track decision time, unresolved objections, documented reasons, appeals and access differences. Review whether the process changes who can participate and who carries the burden. Make a dated decision to stop, revise or extend the inquiry.

Board decision brief

Present the local problem, source setting, evidence limits, intervention, responsible owner, total cost, measured changes and uncertainty. Separate staff perceptions, implementation measures and student learning outcomes.

Attribution and reuse

Hanna Richter; Tatiana Mamontova; Lisa Kühne. Governance configurations of coordination in municipal health promotion: insights from an egocentric network analysis. BMC Health Services Research (2026-08-22). https://doi.org/10.1186/s12913-026-15347-8

Prepared 2026-11-07. Source authorship and DOI are preserved. The abstract and source passages are attributed extracts; this editorial guide is offered under the same CC BY 4.0 license.