Action research for sustainability in the UK National Health Service (NHS) : linking theory and practice in organizational strategy for sustainable development

This thesis is an account of research at two levels of inquiry. At the context-level, it is concerned with advancing theoretical understanding of the challenges to progressing Sustainable Development (SD) in NHS organizations. Previously these had been described as comprising i) lack of organizational support afforded to SD, ii) difficulties in prioritising and evaluating the impacts of SD initiatives, and iii) a dominance of working arrangements inappropriate for dealing with the cross-departmental and inter-organizational nature of SD. At the meta-level, it is concerned with advancing theoretical understanding of an Action Research (AR) approach to addressing such challenges in their context. It seeks to contribute to emerging frameworks which define a co-operative relationship between practitioners as active participants in their own solutions to organizational change for SD, and outside academics as facilitators of appropriate learning processes to support this. I engaged in two phases of research to address both these levels of inquiry. In Phase 1, I developed a theoretical understanding of the challenges of NHS SD through fifteen semi-structured interviews with practitioners and policy makers leading initiatives for SD in the NHS. In Phase 2, I used this contextual theory to inform an AR approach to progressing SD in one NHS organization. In this process, I facilitated cycles of action and reflection with a group of five senior managers over a twelve month period, in order to develop their organization’s SD strategy. Both Phases revealed the constraints practitioners face in developing SD beyond a narrow resource efficiency agenda. AR holds potential for developing broader interpretations through the integration of SD theory into organizational learning process. However, such an endeavour is beyond the scope of a single AR project and must be viewed as an ongoing relationship between academics and practitioners, as well as other actors of influence from across the health system.