Purpose: The purpose of this paper is to demonstrate that organisational sustainability is not a continuation of the status quo but, seen from a complexity theory perspective, is a continuous dynamic process of co-evolution with a changing environment. It is underpinned by learning, and it creates new structures and ways of working to adjust and to continue adjusting to a changing set of conditions. Design/methodology/approach: This longitudinal study concerns two London-based NHS hospitals: a teaching hospital and a District General Hospital. The analysis is based on several sets of semi-structured interviews, group interviews and workshops, conducted in June and July 2005 and again in October 2006 and finally in January 2007. The argument used to analyse narrative data is underpinned by complexity theory and based on two hypotheses and two assumptions defined in the paper. Findings: Both hospitals faced a significant deficit and in addressing it they had to change fundamentally ways of working and relationships, to become capable of learning and changing. Empirical data reveal two different styles of leadership, creating totally different "enabling environments" and illustrate some essential elements of sustainability. Leadership and the creation of an enabling environment are necessary but not sufficient, if the changes have not been embedded within the organisational culture, through a different way of working, relating and thinking. Originality/value: The paper provides theoretical insights in practice through case study exploration to emphasise that the distinctive characteristic of complex systems is their ability to create new order; that is, not simple adaptation, but in this case a different way of working, thinking and relating. A key insight is that sustainability is a continuous process of co-evolution. The paper also highlights the critical significance of leadership styles in fostering or inhibiting learning in organizations and the importance of co-creating enabling environments which facilitate learning. It further demonstrates the value of leaders understanding and working with (not constraining) their organisations as complex social systems. © Emerald Group Publishing Limited
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