Network Accountability in Healthcare: A Perspective from a First Nations Community in Canada*

Abstract

This study examines the role of accountability in the governance and delivery of healthcare to a First Nations community in Canada. Drawing on actor network theory, this study explores the role of accountability in the formation and sustenance of a healthcare network using the case study of a First Nations healthcare organization. The study provides insights into how accountability helps to sustain a network of actors with divergent interests and a plurality of strategies. It finds that network accountability is the central mechanism that motivates the principal actors in the network to reconstitute themselves and converge around the purpose of strengthening governance. This study also finds evidence of accountability as a multidimensional construct that facilitates the sustenance of the federal government as the controlling actor in the network. This study provides fresh empirical insights gained from a flesh-and-blood, actual network that acknowledges the context of a marginalized group—namely, First Nations peoples. Furthermore, this study extends and presents a viable accountability model that can be adopted as the federal government enters into self-governance agreements with First Nations peoples. In contrast to the dominant literature on accountability, this study adopts the unique context of a marginalized group in a market-based developed economy.