Action Research as a Critical Hermeneutic Approach Using Co-Creative Processes to Implement Changes in Municipal Healthcare

Introduction:

In the context of complex societal changes, such as an aging population, evolving knowledge, and shifting priorities, effective healthcare leadership is crucial but often overshadowed by clinical and administrative duties. Leadership development is fragmented, focusing more on individual than organizational competence. While co-creative approaches have been shown to effectively implement knowledge-based change processes, studies exploring the use of action research to collaboratively develop leadership programs are lacking.

Goals and Methods:

This study aims to explore how action research, using a critical hermeneutic lens and appreciative co-creative processes, can drive meaningful change in municipal healthcare through continuous leadership development. Data were collected from 41 participants across three leadership levels, using 16 focus groups, participant observations, and online evaluations from six workshops. Thematic analysis followed Braun and Clarke’s principles.

Results:

Preliminary results reveal that the chosen methodological approach exposed a contrast between the high individual competence of the participating leadership team and the lack of trust limiting its organizational impact. The workshops, co-created by participants and researchers, included focus groups, short presentations, reflective group work, scenario training, and trust-building activities such as shared meals, quizzes, and overnight stays. Central to this approach was appreciative inquiry, which facilitated trust-based reflection, alongside the integration of competence development, collaborative structures, interpersonal safety, and shared values and aims. Participants reported that the program fostered evidence-based decision-making and trust within the leadership team, positively influencing their daily clinical interactions. Focus groups were particularly valued for facilitating reflection.

Conclusions:

Action research was shown as a suitable approach for implementing change processes in healthcare, both directly in the planning and execution of the leadership development program, and indirectly by fostering more trust-based interactions in clinical services.