Steering Through Complexity: Reflexive Insights from organizational participants in a Pre commercial Procurement project for tele-rehabilitation

Background: Health innovation projects often require staff to navigate uncertainty, shifting structures, and contested ownership. The EU-funded ROSIA project is distinctive in using a pre-commercial procurement (PCP) model; an innovative approach designed to stimulate the telerehabilitation market by aligning industry with health system needs. This model brought its own complexity and novelty. To understand how staff experienced steering such an initiative, we explored the perspectives of the National Rehabilitation Hospital (NRH) Steering Group in Ireland.

 

Approach: A focus group was conducted with members of the NRH Steering Group, comprising clinicians, managers, and researchers who had been directly involved in guiding ROSIA. The discussion was audio-recorded and transcribed verbatim. Analysis followed Braun and Clarke’s six-phase process of reflexive thematic analysis (RTA). The study was underpinned by a constructionist epistemology and an experiential orientation to the data, aiming to privilege participants’ meaning-making while acknowledging the interpretative role of the researcher.

 

Codes were developed inductively and iteratively, with both semantic and latent attention to meaning, before being clustered into themes around central organising concepts. Reflexivity was central: the analytic process involved sustained reflection on how our positioning as researchers, and as participants in related projects, shaped interpretation. Themes were generated as interpretative stories rather than topic summaries, seeking to reveal the lived complexity of steering an innovative procurement process within a health system.

 

Results: Six themes were constructed:

Shouldering the burden of uncertainty; participants described the time burden, ambiguity, and sense of being “lost” as they navigated unfamiliar processes.

Challenge as a catalyst for growth; difficulties were reframed as opportunities for learning, preparation, and professional development.

An anchor in the storm; the group itself provided stability, direction, and mediation when institutional understanding lagged behind.

Whose project is it anyway?: tensions of ownership and identity (NRH versus UCD) shaped communication and engagement, influencing buy-in.

Fragility and resilience of relationships; staffing turnover disrupted momentum, while champions and continuity fostered trust and progress.

When structures constrain innovation; the novelty of the PCP approach, coupled with procurement demands and dual solution models, introduced systemic barriers that complicated engagement.

 

Implications: This analysis shows how Steering Groups can simultaneously buffer and amplify the challenges of system-level innovation. The PCP model, innovative in its design, intensified the sense of uncertainty for participants but also created conditions for learning and growth. Success was contingent not only on technical structures but also on ownership, relational continuity, and communication.

For international delegates, this study demonstrates the value of reflexive evaluation in surfacing the lived experience of staff engaged in innovation, highlighting transferable lessons for embedding procurement-driven change in complex health systems. By adopting a reflexive lens, we show how meaning is co-constructed at the intersection of individuals, organisations, and novel procurement models; insights that are relevant wherever health systems seek to innovate through integration.