An autoethnographic reflection on the creation of adaptive space to develop integrated care

What the paper says

Purpose This paper aims to explore the complexities of creating adaptive space in a healthcare system to develop integrated care programmes. It draws on the author’s experience as a senior clinical leader to analyse how adaptive processes emerged within a national reform initiative. Design/methodology/approach An analytic organisational autoethnography was undertaken, using multiple data sources including contemporaneous journals, organisational documents, artefacts and reflective dialogue with colleagues. Data were analysed abductively, using Arena and Uhl-Bien’s four dimensions of adaptive space (discovery, development, diffusion and disruption) as a guiding framework. Findings The analysis demonstrates how adaptive space was created through intentional bridging of clinical and operational domains, cultivation of knowledge-broker roles and development of relational connections within and beyond the organisation. These adaptive processes were fragile, contingent and often resisted, yet enabled innovation to surface and spread. The study shows how leadership practices of reflexivity, positional negotiation and boundary work shaped outcomes. Originality/value This paper contributes to debates on complexity leadership and organisational ethnography by offering a rare insider account of leading integrated care reform. It advances theoretical understanding of adaptive space as a dynamic social process and demonstrates the methodological value of analytic autoethnography for capturing the interplay between personal experience and organisational transformation.