Collaborative strategizing and distributed complexity as response to grand challenges: The case of integrated healthcare systems

This study explores an initiative within the UK healthcare sector to tackle grand challenges in the provision of healthcare by a push for more open and collaborative forms or organizing and strategizing. We analyze how actors within a local Sustainability and Transformation Partnership (STP) introduce novel forms of collaborating beyond established bureaucratic systems in the sector. We thereby show how the mandated push towards more open organizing created several underlying tensions and dilemmas related to the complexity and scope of the grand challenge, and competing demands from the bureaucratic system and inclusion and exclusion. Our paper identifies a repertoire of practices that underpin the cyclical process of complexifying versus simplifying grand challenges. We show how these practices conjointly distribute complexity across an inter-organizational system, as actors parcel and move complexity into different pockets of the system, enabling dynamic participation and continuously broadening contributions to collaborative strategizing work.