Organisational change is often driven by strategy, structure, and leadership. Yet beneath these formal mechanisms lie the socio-cultural and linguistic foundations that shape how change is understood, enacted, and sustained. This dissertation explores these foundations through the case of introducing coproduction of care—specifically, the ESTHER Network —within Singapore’s public healthcare system. Originating in Sweden, ESTHER Network represents a shift toward collaborative, person-centred care, making it a useful lens to examine how coproduction is translated in hierarchical and efficiency-oriented health systems.

Using an insider action research approach, the study investigates how managers, practitioners, and service users interpret and negotiate coproduction in practice. Multiple qualitative and quantitative data sources—including interviews, focus groups, observations, document analysis, and a validated survey—were analysed iteratively and triangulated to capture both the structural and relational mechanisms of change.

The findings show that coproduction in Singapore remains at a nascent stage, often enacted as improved communication from practitioners to improve treatment adherence rather than genuine power-sharing. First-order change in terms of structural support—such as achieving innovation–system fit, strengthening vertical integration, and training—helped establish alignment and coherence in the early stages. Service users’ past experiences with practitioners significantly shaped current interactions, providing insights to the challenges in translating coproduction in practice. Signs of second-order change emerged through the work of ESTHER coaches and champions, who bridged service users, practitioners, and managers, fostering relational shifts. Dialogue, enacted through structured cross-boundary spaces such as ESTHER cafés, was identified as a critical mechanism for generating shared understanding and new meanings of care. These encounters acted as microstructures for change, helping teams navigate complexity and ambiguity.

Interpreting these findings through the lens of change as a socially constructed process, the study demonstrates that sustained transformation emerged from the ability as an organisation to adapt – understanding the critical and often overlooked role of culture, values and shared meanings. This form of third-order change requires individual and organisational reflexivity – deep understanding comes from not resolving the tensions of change superficially but engaging with them adaptively. The dissertation culminates in a reflexive model for adaptive working, which articulates five interrelated dimensions to guide dialogue, learning and reflection, to enhance deeper understanding between service users and practitioners. This model contributes a practical and relational framework for navigating adaptive challenges in complex systems.