Non-Government Organization Leadership in National Healthy Public Policy for Chronic Disease Prevention in Canada: A Grounded Theory Study

Abstract

Chronic non-communicable diseases are leading causes of avoidable premature disease, disability, and mortality in Canada and abroad. Non-government organizations (NGOs) play a key role in national healthy public policy development for chronic disease prevention in Canada. Their role is dynamic within a complex, ever-changing, multi-level system involving many players and contextual factors. This study explores their role and the emergence of leadership in the complex, adaptive policy-making system at the national level in Canada. The intent of this research was not to prove a particular theory or even to provide a generalizable, explanatory theory of leadership from a particular theoretical perspective. Instead, the research explored leadership as a relational phenomenon in a specific public health context and asserted an understanding that might inform research, practice and theory of the phenomenon within that setting (i.e. NGOs in complex adaptive systems for healthy public policy development in Canada). Employing critical realism as an ontological and epistemological stance, the study used an interpretive methodology and a grounded theory emerged from an analysis of the stories of key NGO actors. These were obtained through semi-structured interviews with 14 NGO policy experts about their experiences in national healthy public policy for chronic disease prevention in Canada. The research explored participants’ narratives in relation to NGO leadership and compared findings to the extant literature and sensitizing concepts to help extend and explore the data. The analysis focused on six perspectives of the complex adaptive system and new insights emerged through realist inductive, abductive, deductive and retroductive inferential processes. This study asserts a definition of leadership as an emergent, temporal, social, systems’ phenomenon independent of the actions and capacities of individuals. Further, NGO leadership emerges from the activity NGOs perform in the system (i.e. advocacy). NGO leadership in this context is an emergent function dependent on the NGO's structure and structural, “outsider” position within this complex adaptive system. It is expressed as a social learning process employed collaboratively to achieve chronic disease prevention aims. The theory asserts specific conditions that must exist at organizational and inter-organizational (coalition) levels to allow the emergence of NGO leadership. This study concludes by opening new possibilities for the exploration of leadership beyond the actions and capacities of individuals to frame leadership as an emergent, temporal, social phenomenon in complex adaptive systems.