Emergence of complexity leadership in a national rehabilitation hospital through cooperative inquiry

BACKGROUND: Healthcare systems are increasingly characterised by complexity, uncertainty and the need for adaptive leadership. This study reports on a cooperative inquiry conducted with senior medical professionals in an Irish public rehabilitation hospital during the COVID-19 pandemic and a concurrent hospital relocation. The inquiry aimed to explore how reflective practice and collaborative learning could support leadership, well-being and organisational change in this dynamic context. METHODS: The cooperative inquiry involved six iterative cycles with 4-12 participants per session over an 18-month period. Participants engaged in structured reflection, collective dialogue and co-designed actions. Qualitative data were drawn from meeting notes, reflective journals and outputs such as action plans and feedback loops. Analysis focused on emergent themes across the cycles and evaluation of enacted changes. The process was informed by complexity leadership theory and action research methodology. RESULTS: Key themes that were generated across cycles included trust, connection, psychological safety, professional isolation and adaptive leadership. Actions included establishing new communication platforms (eg, WhatsApp groups), embedding reflective practice, engaging with executive decision-making structures and initiating governance innovations. Participants reported increased capacity for navigating complexity, improved collegial support and expanded organisational influence. Reflective practice and relational leadership emerged as core mechanisms of change. CONCLUSION: The inquiry demonstrated how cooperative, reflective processes can support the emergence of adaptive and relational leadership and enable organisational learning in complex healthcare settings. Even under conditions of crisis and constraint, participants cultivated a learning community that contributed to meaningful professional and systemic development. The study provides an empirical account of the mechanisms through which cooperative, reflective processes support the emergence of adaptive and relational leadership in complex healthcare settings.