Code book (in Dutch).

ContextIn the Netherlands inter-organizational networks have been established to drive long-term healthcare improvement on a regional and national scale. Managing healthcare networks is challenging, especially in sustaining participants’ active engagement. This study aims to empirically explore why participants’ network commitment declined and how network commitment was managed by network coordinators.MethodsWe conducted an exploratory qualitative study using purposive sampling we held semi-structured interviews with representatives from 18 Dutch healthcare improvement networks.ResultsRespondents mentioned that allocated time and continued participant commitment was required to reach their goals. A key challenge was the decline in participant commitment over time due to misalignment of goals and needs, slow progress, lack of reciprocity, and resistance to change at the organizational level. Approaches to manage this were collaborative reassessment of goals and needs, expectation management, setting preconditions and fostering personal relationships.DiscussionOur findings highlight the importance of strategic timing of managerial approaches and their interdependencies with social mechanisms. These insights contribute theoretically to Ring and Van de Ven’s framework on developmental processes of cooperative interorganizational relationships and offer practical guidance for network managers aiming to maintain long-term commitment.