Consensus-driven governance in Brazil’s public healthcare: a network based on collaborative decision-making

Purpose This study examines the governance dynamics of the Brazilian Unified Health System (SUS), with a particular focus on the network governance mechanisms that contribute to its operational effectiveness. Design/methodology/approach A qualitative case study was undertaken focusing on Conass, a strategic public healthcare network in Brazil. The research employed document analysis and 17 semi-structured interviews with key members of Conass to explore governance practices and dynamics. Findings The analysis reveals that Conass’s effectiveness is grounded in robust network governance, characterized by core functions such as strategic alignment, inter-organizational coordination, monitoring, and arbitration. These functions are operationalized through mechanisms including conflict mediation, expectation alignment, collaborative goal-setting, policy co-creation, and performance evaluation, all sustained through collective decision-making processes. Originality/value The originality of this paper lies in its application of process research methods to reveal how consensus functions as a key governance mechanism in conflict resolution. By bridging theory and practice, the research extends the current theoretical framework, illustrating how structured routines and micro-governance functions sustain collaboration and authority. It contributes new insights into managing tensions and decision-making in complex, horizontal governance networks.