title: Unpacking the black box of medical leadership in complex adaptive systems: a co-operative inquiry in a national rehabilitation hospital
Creators: name: Carroll, Aine
Publisher: name: University of Reading
Year: 2023

description: This thesis embraces a participatory and complexity perspective to further understanding of 
complexity leadership in a healthcare organisation during a period of turbulent change. It uses
the co-operative inquiry articulation of action research to create an adaptive space to facilitate 
the adaptive process of complexity leadership development in medical consultants.
Using the Shani and Pasmore (1982) complete theory of action research (context, quality of 
relationships, quality of the action research process and dual outcomes) the transcontextuality 
of the research was explored through global, national, local and personal perspectives. 
Through preunderstanding activities and analysis of multiple sources of data, it was revealed 
that medical consultants felt isolated and disenfranchised and desired to collaborate together 
for change. Colleagues transitioned to become co-researchers who then participated in six 
cycles of action research through a dynamic, emergent process of change and knowledge
production, where data were generated through action and reflection-in-action and reflection-on-action.
The co-operative inquiry created the rich connections necessary to explore areas of mutual
concern and share ideas and information and take action to solve some of the problems 
identified. By creating the necessary structures, processes and events, adaptive outcomes of 
new complexity leadership skills and behaviours with an enhanced experience emerged.
Through the inquiry, it became apparent that consultants’ basic needs were not being met, a 
form of organisational injustice. There were four inquiry outcomes that corresponded with the 
four forms of knowing: experiential, presentational, propositional and practical. Personal 
transformations occurred through engagement with the focus and process of the inquiry. Co-researchers presented insight about leading in complexity through oral and verbal modes of 
presentation. The co-created propositional report which was generated at the conclusion of 
the inquiry was informative about leading in complexity and what it meant for us as a group
(and me in my dual roles as researcher and organisational member) and it provided 
commentary on the inquiry outcomes and described the method of inquiry. Co-inquirers 
demonstrated the practical skills of transformative action and complexity leadership skills. 
Through the subsequent integrative meta-cycle, two overarching themes were identified as 
necessary for leading in complexity in our organisation: the development of communicative 
space and the enactment of teamwork.
Using the themes and subthemes that emerged from the reflexive thematic analysis, a 
dynamic framework for the creation of adaptive space to enable complexity leadership 
development emerged.
The co-operative inquiry process enabled co-researchers to recalibrate perspectives 
concerning the nature of our organisation and our world. This research challenges the 
characteristic reductive thinking of healthcare improvement. Whilst in complex healthcare 
organisations the impact of an intervention may be unpredictable, this inquiry opened the 
communicative adaptive space in a complex system and allowed new leadership skills and 
behaviours to emerge. The findings of this research may help scholars and practitioners to 
effectively engage with, explore and intervene in a complex system and enhance our
understanding of complex systems and leadership.