Exploring the Black Box of Medical Leadership in a National Rehabilitation Hospital: A Co-Operative Inquiry.

Introduction: In 2020, the National Rehabilitation University Hospital (NRH) in Ireland, a complex specialist rehabilitation hospital transitioned to a new building. This transition presented a unique opportunity to explore interdisciplinary team dynamics, integration, connections and relationships within and across teams. Part of a larger project, this paper presents the results of a co-operative inquiry with the Medical Consultants. Aims and objectives: To assess the value of co-operative inquiry as a vehicle for supporting learning. The specific questions to be addressed were: •How can we as medical leaders facilitate transition to the new hospital with an improved staff and patient experience? •How might we develop the leadership skills to do this? Methodology: Action research (AR) was chosen because, similar to the biopsychosocial model of rehabilitation, it supports a collaborative, democratic approach to research based organisational change and improvement. Cooperative inquiry (CI) an experiential, participatory articulation of action research, was chosen as it has a solid evidence base in professional development in healthcare. In this articulation, small groups of co-researchers engage, in a non-hierarchical manner, multiple ways of knowing through cycles of action and reflection to explore areas of shared concern. Data generation: Data was generated from 6 action research cycles, with participants engaging in an 'extended epistemology' of experiential, presentational, propositional and practical ways of knowing. An integrative triangulation approach incorporated the first, second and third person inquiries. As there were multiple cycles of inquiry, there was a continuous process of innovation and data generation. A process folio approach was taken, to document, describe and analyze the data using a 10-step cyclical framework. Data analysis was ongoing, cyclical and reflexive, with participants engaging in the sense-making process at each session. Results: Through cycles of action and reflection, 2 key themes emerged; Communication and teamwork. Actions taken included the identification and creation of physical space to come together physically (Coffee room, informal get togethers) and virtual spaces (WhatsApp; Virtual meetings). These enhanced discovery, development, diffusion, and disruption connections. WhatsApp content analysis revealed an active dynamic exchange of diverse information that became a network of collaborative learning. These activities were supported by senior management through the 3rd person inquiry. 75% of participants felt our objectives were met. Through a process of abductive reasoning, colleagues felt they had learned to communicate better, trust, share and learn together and also patience and friendship. There was a commitment to continue as an action learning set. Conclusions: Cooperative inquiry, with a focus on action and shared reflection, facilitated the 'inpowerment' of a diverse group of colleagues to work together to develop practice in areas of mutual concern. CI was an effective vehicle for supporting learning which resulted in the stated goals of improved communication and teamwork. Implications and limitations: This study found that CI is a useful developmental method for teams engaging the collaborative dynamics of action and inquiry and the outcome of actionable knowledge. Although this approach was tested with 1 group, the approach is being extended to other groups within the organisation. [ABSTRACT FROM AUTHOR]