How an inter-organizational network hub orchestrates collective leadership to advance population health.

Inter-organizational networks are increasingly used to address complex health challenges, yet little is known about how "hub" organizations at the center of such networks cultivate relational processes that enable network effectiveness. Drawing on organizational network and collective leadership theories, we examined the relational processes that a structurally central hub organization used to influences a multi-sector network. We used in-depth qualitative methods to study a local health department that served as hub of a network of over 25 organizations establishing new behavioral health crisis response services. Over three years (2022-2025), we collected data through 49 interviews, 21 meeting observations, and 66 days of ethnographic field observations. We found that in its network hub role, the health department engaged in both externally and internally-directed relational processes to orchestrate collective leadership of the inter-organizational network. The hub's function as an orchestrator of collective leadership was prominent across multiple instances in which network goals or network integrity were at risk, pointing to orchestration of collective leadership as a key process through which the hub organization supported network effectiveness. In particular, the hub orchestrated leadership to manage three tensions that arose in its network: 1) sustaining external partners' engagement during service scale-up, 2) managing internal organizational change to deliver network goals, and 3) enabling frontline collaboration across professionals from different network members. Our findings suggest that the ability to orchestrate complex leadership processes is a core competency for successful network hubs, with implications for the technical assistance and timelines needed to support such initiatives.