Empowering leaders to shape future strategic pathways: A Dynamic Adaptive Decision Support model informed by Healthcare Organizations

In response to the challenges posed by rapidly changing environments, this dissertation presents a Dynamic Adaptive Decision Support model (DADS). This innovative approach, grounded in Decision Making under Deep Uncertainty (DMDU), is designed to support organizations and their leaders in strategic decision making through structured and interdisciplinary collaboration. Following a design research approach, this dissertation comprises four interconnected studies: Investigation, Creation, Evaluation, and Utilization.
The first study, problem Investigation, is a qualitative study examining how decision makers respond to unforeseen developments during strategic decision-making processes. The study reveals that decision makers face deep uncertainties, particularly regarding future real estate financing, yet rarely quantify the level of uncertainty. Furthermore, it highlights a gap: the absence of robust, adaptive planning tools capable of addressing the deepest level of uncertainty in strategic decision making. This finding underscores the need to develop a dynamic and adaptive planning approach.
In the second study, Creation, the Dynamic Adaptive Decision Support model (DADS) was developed to improve strategic decision making within organizations. The model consists of a seven-step procedure that guides leaders from defining the context to monitoring implementation. It was evaluated using the criteria relevance, observability, completeness, and parsimony, and applied in the context of healthcare organizations. The central outcome, a map of future strategic pathways, visualizes alternative sequences of strategies across multiple plausible futures. DADS enables proactive, ongoing and strategic decision making rather than one-off planning.
The third study, Evaluation, comprises a longitudinal, quasi-experimental investigation of the impact of DADS on stewarding capacity, a concept adopted from public policy and applied in an organizational context. Stewarding capacity encompasses generating knowledge, strengthening self-organization, and fostering monitoring and continuous learning. The findings reveal that DADS strengthens key capacities for strategic decision making and enhances organizational resilience. At the same time, challenges emerge in operationalizing stewarding capacity across interorganizational settings and networks. This study demonstrates that DADS has the potential to evolve into a transformative approach for strategic planning and management in healthcare.
In the fourth study on Utilization, a multiple-case study examines how the application of a dynamic adaptive approach influences adaptive leadership within strategic processes. Adaptive leadership enables organizations to navigate unpredictable challenges by fostering resilience, learning and change, while the dynamic adaptive approach supports strategic decision making under deep uncertainty. The findings show that the applied DADS strengthens a supportive environment and encourages behaviors and mindsets associated with adaptive leadership. However, the study also reveals limitations: a single workshop is insufficient to fully design an organizational intervention or to develop adaptive leadership capabilities. Iterative and ongoing engagement is necessary to build strategic resilience and adaptive capacity.
This study demonstrates how a dynamic adaptive approach within strategic decision-making processes empowers adaptive leadership in today’s rapidly changing environment.
Overall, DADS empowers organizations and their leaders to navigate deep uncertainty, integrate multi-level strategic decision making, and increase organizational resilience. This research advances the understanding of dynamic adaptive planning as a catalyst for future-oriented and collaborative strategic processes in dynamic environments, empowering leaders to shape future strategic pathways.