Figure 4. Programme Theory for a Network Intervention to achieve large scale change across multiple Kenya hospitals.

The central network operates at the interface between national stakeholders and hospitals, what we consider level 1 in this network system. It bears responsibility for engaging with and providing timely performance information to key departments in the national and county governments and to the paediatric and nursing professional associations. At the same time this central team is responsible for providing hospitals with feedback on performance using quality indicators and working with NBU leaders to create and build a peer-to-peer network that includes face-to-face meetings, and provide expert outreach using a mentorship model, and co-opting additional resource persons to support the development of leadership, management and communication skills of NBU leaders and teams. The selection of these intervention components reflecting identified challenges and prior experience of successful intervention ^{16, 33, 45, 48, 58, 63, 71, 76, 98}. The NBU leaders operate at what we consider to be level 2 in the network system, interfacing with the central network but also their hospital specific NBU teams and senior management. At level 3 in this system are the frontline workers led by their team leaders who are the critical interface with the sick newborns themselves and their families. The Central Multi-Professional Network team members may have little direct contact with or influence on events at level 3, any network effects will therefore predominantly be mediated by those at level 2. The paediatricians and senior nurses at this critical level 2 juncture, who operate at the mid-level of the hospital’s management structure, have rarely been prepared for their leadership roles or given any specific support to build the relational skills that are likely critical ^{63, 71, 98}. Enhancing the capability and motivation of these level 2 individuals is therefore a key aim of the network intervention.