Evaluating a leadership development program through co-design and insider outsider action research

This paper reports on the establishment of a co-designed evaluation project of a pilot leadership capability development program in a rural health service in Victoria, Australia. Central Highlands Rural Health (CHRH) provides acute, primary, community, and aged care services across five sites in two local government areas to a population of over 60,000 people. The Australian rural healthcare sector faces a number of key challenges including workforce shortages, work intensification due to budget restraint, ageing demographics of staff and consumers and employee engagement. Against this background, CHRH identified the need to develop from within, leaders who can engage and support their staff in providing high quality care to patients and carers. In early 2024, CHRH established the Positive Leadership in Rural Health (PLiRH) Program. The program steering committee invited a research team from RMIT University, Victoria, Australia to evaluate the impact of the pilot PLiRH program through a co-design process.

The human resource management (HRM) discipline is often criticised for its ineffective integration of practice. Lau et al. (2025) call for more action-based research underpinned by effective research partnerships and Kaufman (2022) notes that the management literature is usually “on” practitioners and rarely “with” them. Lau et al. (2025) argue that evidence-based practice in HRM is in its infancy and highlight the importance of academics working with practitioners to develop interventions. In this paper we take up this challenge. In their quest to bridge the research practice gap in HRM Lau et al. (2025) identify three key groups or ideal types – impact driven academics – these are academics who strive to demonstrate the real-world impact of their research; reflective practitioners who value academic perspectives and “pracademics” - these are hybrid academics who actively engage with academia but also have a practitioner role. We draw on this typology and focus on the establishment phase of the project, particularly the co-design process. We capture impact and outcome from the perspectives of the Evaluation Team which included two impact focused academics, four reflective practitioners and one pracademic. The paper is structured as follows. First, we outline the problem leading to the establishment of the PLiRH program, second, we describe the program and third, we identify the approach taken by the Evaluation Team in developing an Evaluation Action Plan. Fourth, we explore the different perspectives of reflective practitioners, impact driven academics and the pracademic in the Team, in relation to the impact of the process. Finally, we discuss our key learnings in understanding the role of HRM in driving impactful outcomes in healthcare organisations and draw conclusions.

Leadership is critical in all organisations and is a key factor that impacts on employees' well-being and performance in healthcare (Shipton et al., 2008; Stanton et al., 2010). Like other rural healthcare providers CHRH faces many key challenges. First, the difficulty in recruitment and retention of staff due to the scarcity of qualified staff living within commuting distance, as well as limited budgets, poor public transport, limited access to professional development and lack of affordable housing (Gillespie et al., 2022; Martin et al., 2025). Second, rural communities often have populations with poorer health outcomes, in particular, ageing populations. Meaning that managers and staff are under constant pressure to do more with less and fill gaps in care (Mullan et al., 2023). Third, rural healthcare staff are more visible and accessible in their communities, and they often face personal as well as professional pressures (Cosgrave et al., 2018). Fourth, healthcare has a history of promoting expert clinicians into management and leadership roles with little training making them ill-prepared for the complex leadership challenges, often leading to early burnout or resignation (Fulop and Day, 2010; Hartviksen et al., 2024). Finally, while the demand for healthcare continues to grow, the workforce shortages will become more acute (Department of Health, 2024).

Leadership development programs are often identified as the answer to difficult problems, however, there is a question over the effectiveness of generalist programs, and this is particularly true in the public and not for profit sectors (Bond and Chong, 2020; Fulop and Day, 2010) Fulop and Day (2010) argue that many leadership development programs in healthcare fail because they don't understand that many healthcare managers can be reluctant leaders as they are in hybrid professional-manager roles and often identify more closely to their profession rather than their organisation. Furthermore, evidence suggests that leadership development cannot be separated from context and culture and that leadership is a shared construct with multiple stakeholders and needs to be tailor-made to the situation (Fulop and Day, 2010; Turner et al., 2018).

The CHRH Board and Executive identified the recruitment and retention of staff as a strategic priority and the importance of a tailor-made approach. In 2023, an Organisational Development (OD) Manager was appointed with the brief to design, develop and implement a leadership program to positively influence the CHRH culture into one which people would want to join and want to stay. A key aim was to develop from within, leaders who can engage and support staff in providing high quality care to clients and carers.

The PLiRH involved a multitude of stakeholders across the organisation. It commenced in March 2024 through the recruitment of 15 participants (trainees) from across the organisation chosen through a call for Expressions of Interest. The OD Manager also invited eight executive level mentors and six senior coaches from across and within the organisation to join the program. Each had between one to three participants to coach or mentor. Moreover, all program presenters and facilitators were also from within the organisation. Six full day workshops were planned at regular intervals in the first six months with follow up action required of participants between workshops (see Figure 1 for the PLiRH program). Broadly, the interactive workshops covered positive leadership theory, emotional intelligence, change and project management and soft skills. Each participant was provided with monthly individual coaching and mentoring. Peer groups of five participants were formed and also encouraged to meet monthly. As part of their action learning, participants had to identify a workplace project that they would plan, implement and evaluate over the term of the program supported by their coach. The line management and cross functional managers were also involved due to the focus on employee development within the projects. The coaches and mentors met at the beginning of the program in two separate groups with the OD manager who explained the purpose of the program and their role within it. At the end of the program trainees presented their projects to senior executives, board members, and peers.

Most leadership programs are evaluated based on short term individual level outcomes, mainly from the participants' perspective (Langmann and Thomas, 2019; Njah et al., 2021). This is particularly problematic in public healthcare, where far reaching outcomes and impact are necessary due to the leadership challenges of the industry (Njah et al., 2021). The Evaluation Team was established in July 2024 soon after the first workshop for the purpose of developing an Evaluation Framework and an Action Plan that could capture a range of perspectives at different time points. The Team included four reflective practitioners namely the Director of People and Culture (DP&C), the Organisation Development Manager, a Director of Nursing (DoN) and a People and Culture Advisor; as well as two impact driven HRM academics and a pracademic – a CHRH Board Member who is also a HRM academic. Evaluation by its very nature is focused on impact and outcome, this paper focuses primarily on the co-design process of the Evaluation Framework and the development of the Action Plan in Stage 1 and the impact on the Evaluation Team members rather than the impact on the participants.

• Stage 1 of the evaluation involved a number of Evaluation Team meetings to co-design the Evaluation Framework and develop the Action Plan. It also included collecting key documentation, a meet and greet with the participants, observing part of a workshop and a tour of the key health service sites by the RMIT team. Stage 2 involved implementing the Evaluation Framework through holding focus groups and interviews with trainees, mentors, coaches, line managers of participants and senior executives (see Figure 1 for the Evaluation Framework).

Paauwe and De Voorde (2025) argue that bridging the HRM research and practice gap is elusive and often fails due to knowledge transfer and knowledge production challenges. The Evaluation Team used three key elements to bridge this gap. First, the evaluation was co-designed by the whole Evaluation Team. Co-design underpins multi stakeholder involvement and agreed upon outcomes based on the analysis of the context through critically engaging participants and exploring their real-world experiences (Coulston et al., 2024; Goodyear-Smith et al., 2015). Second, it is an action research project which is iterative and involves feedback and action points at key stages across the project involving all members of the team. Increasingly, HRM scholars have acknowledged the contribution action research has on bridging the gap between scholarly knowledge and practice (Bleijenbergh et al., 2021). Third, we underpinned this process by capturing, comparing and valuing impact driven academics, reflective practitioners and “pracademic” perspectives of the process through a range of measures including personal reflection, observations and meetings.

Since its introduction in the 1970s as a collaborative tradition rooted in the participatory design movement (Masterson et al., 2022; Schwab, 2021), co-design has evolved and has been used in a range of contexts (Coulston et al., 2024; Masterson et al., 2022). Co-design facilitates the identification of end user needs, authentic and pragmatic solutions to real world challenges and promotes collective ownership of interventions thereby increasing the likelihood of successful outcomes (Mucheru et al., 2024; Slattery et al., 2020). It is argued that the value of co-design is dependent upon harnessing diverse knowledge and insights representing the broad perspectives of different stakeholders (Iniesto et al., 2022). Inherent to co-design is the effort to address power imbalances of the participants and harnessing collaborative knowledge by encouraging researchers, practitioners and communities to share responsibility for various aspects of the process (Del Gaudio et al., 2020; Iniesto et al., 2022).

Research on co-design in healthcare, emphasise the importance of fostering inclusive and safe spaces for all participants to discuss and reflect on the alignment of individual motivations (Ní Shé and Harrison, 2021; Ní Shé et al., 2019; O'Donnell et al., 2019) and provide social interaction, both formal and informal (Nic Giolla et al., 2022). Other key aspects include establishing a positive team climate, encouraging open discussion through strong working relationships, trust and collective leadership, as well as ensuring equity by preventing possible domination by leaders and researchers. Moreover, accepting the iterative nature of the process, resource commitment, and leadership engagement and commitment from inception to the implementation of change also play a vital role in the success of co-design (Bedenik et al., 2024; Pallesen et al., 2020).

While there is limited application of co-design in HRM research there is a growing interest and appreciation but rare application of action research in HRM (see Bleijenbergh et al., 2021; Lau et al., 2025). Action research offers the opportunity to study complex interactions of different variables or factors within its actual context. Scholars call for more application of action research to ensure widespread and multi-faceted impact especially in the context of leadership development (see Hartviksen et al., 2024) and OD (see Githens, 2015). Brannick and Coghlan (2007) describe action research as having two research cycles operating in parallel. The first is the application of a model and the second is the ongoing process of reflection which as Bleijenberh et al. (2021) argue, can include a range of objective and subjective measures.

However, action research interventions in healthcare do not always go according to plan due to conflicting goals of key stakeholders, inherent power relationships and different understandings of the problem (Young et al., 2015). A growing emphasis on insiders' involvement in action research inspired our insider-outsider approach (Eden and Huxham, 1996; Brannick and Coghlan, 2007). This novel approach to extend the involvement in design and implementation stages, ensures a multi-stakeholder approach to action research for a more critical, holistic, objective and effective evaluation, as well as providing solutions for future HRM and healthcare management researchers. Insider research can be collaboration between insiders and outsiders including academic researchers and is often linked to action research in that the research takes place over time and involves cycles of activities. Insider research is often described as research carried out by complete members of organisations who are native to their setting who have an organisational career path and who wish to remain in their organisation after the completion of the research (Brannick and Coghlan, 2007; Coghlan and Hoolian, 2023). Insider research differs from participant observation in that the insider belongs to the organisation and wishes to stay (Coghlan and Hoolihan, 2023).

Insider research has been criticised because the role of complete members can be seen negatively describing them as “too close”, not able to be objective and too influenced by organisational politics (Brannick and Coghlan, 2007; Coglan and Hoolian, 2023; Morgan, 2006). Furthermore, insider researchers are often warned that the dual roles of investigator and practitioner or employee are incompatible leading to role conflict (Brannick and Coghlan, 2007). Workplace relationships can be damaged without role clarity, confidentiality, definition of boundaries, and ethical behaviour (Morgan, 2006). However, benefits of insider research include a deep understanding of the culture of the organisation and the informal structures and networks, as well as organisational history, language and established relationships (Brannick and Coghlan, 2007; Coglan and Hoolian, 2023; Morgan, 2006).

For the purpose of this paper, we used an autoethnographic approach to our data collection involving all members of the Evaluation Team. Autoethnography has become increasingly common in a range of disciplines particularly those that focus on professional practice (Denshire, 2014). Autoethnography “allows for more than a single researcher/participant, each sharing their own story in relation to the stories of the other researchers/participants” (Grenier and Collins (2016, p. 363). Denshire (2014) argues that juxtaposing such different narratives provides a “layered” account that challenges a single telling from one perspective and which is particularly important in practice research. Autoethnographic enquiry can capture and cast light on complex dynamics and challenges by demonstrating both differences and similarities between the storytellers (Jones et al., 2023). By describing these incidents from different perspectives, we allow insight into our own feelings and emotions as well as combined hindsight that emerges from collective reflection later (Jones et al., 2023). These juxtapositions can also lead to collaborative accounts and Denshire (2014) argues that autoethnography has the potential to “speak back” or differently, creating space for dialogue with previously silenced others.

The research questions reported in this paper were directed to the Evaluation Team members. We asked: What does impact mean to you? How do you think the program is creating impact and how has the program impacted on you? In response, the two impact driven academics and the pracademic provided written self-reflections on these questions. The four reflective practitioners provided a collective written reflection after a brainstorming session. They subsequently provided individual reflections verbally, during one of the Evaluation Team meetings. The reflections took place once the Evaluation Team had met several times, and the impact driven academics had conducted the focus groups and follow up interviews and presented the initial findings Hence, the data was collected once Stage 1 was complete and Stage 2 had begun, and the project was ongoing (see Figure 1). The data was analysed through narrative inquiry (Cortazzi, 2001) by the third author, cross checked with the first and second authors and then shared with the Team in the process of writing this paper. Autoethnography allows the author to move beyond the personal story into the analysis and interpretation of their lived experience or a phenomenon (Chang, 2008), where the subject of knowledge and observation are unified. In this process, the researchers become both subject and object (Richards, 2008) and interpret and analyse their own reflective narratives (Grenier and Collins, 2016). The constant feedback loops of the co-design and action research process led to a co-constructed autoethnography, where small groups of researchers share their personal reflections of a shared experience and form a co-constructed and integrative narrative (Grenier and Collins, 2016). This co-constructed autoethnography took place as a natural occurrence during data collection and analysis.

Following the first iteration of focus groups the academics asked all members of the Evaluation Team for a written self-reflection of the impact of the early part of the evaluation process on themselves. We capture their responses in three groups – the impact driven academics, the reflective practitioners and the pracademic and present the findings that encompass the learning processes experienced by the Evaluation Team.

Both academics wrote about their excitement in being invited to take part in this evaluation project of an organisation in the health and aged care sector. A key issue was their motivation to make a difference and to solve problems.

The academics also highlighted their early interactions with the organisation and their first meetings with the reflective practitioners noting their passion and enthusiasm. A1 commented on the organisation's monthly newsletter:

The cover page featured an image of the program participants along with a message from the chief executive officer on building the next generation of leaders. To me, this was more than a staff communication about a training program. This was visible commitment of leadership to nurture talent. I felt, we were bound by a common objective, to elucidate best practices in leadership development in rural healthcare for others to emulate.

Both academics identified the importance of the informal and relational aspects, for example the academic visits to the different sites of the organisation. As Academic 1 wrote:

This gave us the opportunity to meet the Evaluation Team members face to face (we had met virtually) and several other senior staff members. We were able to observe the daily operations and clients in their everyday surroundings. It appeared that every unit manager knew about the leadership program and someone participating. To me, the highlight of the day was meeting the 15 participants where our role in the project was explained … We mingled casually … this was an ideal opportunity to build rapport and familiarity. This I believe helped the participants feel confident and comfortable to freely converse during focus group sessions which were integral to the evaluation process.

A2 wrote about the importance of role clarity within the team and the important role of the pracademic in providing knowledge about the organisation and explaining key issues.

Both academics were confident about the value of the project and their part in the evaluation.

This development program is very important for the industry to ensure sustainable workforce development and performance … our involvement as outsiders makes sure that the participants, facilitators, and champions of the program have a private and confidential platform and emotionally neutral outside experts to provide their feedback to. This benefits the designer of the program as well because they can improve the program for better outcomes and benefits for all stakeholders involved (A2).

A1 commented that while there was a structured project plan, the process was also fluid and organic:

She went on to say:

For A2:

The practitioners approached the reflective question very differently. They met and carried out a group brainstorm. Rather than reflect on their part in the process, they were much more task focused and identified what they saw as early indications of impact and outcome of the PLiRH program. They captured these under three key headings, first, organisational – what the program had done or was promising to do to address the challenges of the organisation. Second, personal – focusing on the participants (trainees of PLiRH program) rather than themselves (practitioners/management). Third, the community – in particular potential improvements in service delivery and building partnerships with other organisations in their region.

The academics followed up with the reflective question when we next met as a group. How has this process impacted on you so far? The OD manager spoke about her experience of moving from a consultant in the industry to an employee and how as an employee she was able to see the impact “as the ripples move across the organisation”. She spoke about her pride in “hearing the language change across the organisation as participants gained confidence and put their learnings into practice”. She also noted that “tapping into the internal expertise revealed a wealth of great teachers/coaches and mentors and not only was it more or less ‘free’ but local leaders brought local and relevant real experience and practical expertise. This also acknowledged those people as having that expertise and experience to share – it recognised their contribution”.

She also spoke about the trust that had been built up between participants (trainees), coaches and mentors. She stated:

The DoN identified the importance of networking and how involvement in the project had helped her in getting to know the organisation better. She stated: “it expanded my horizons by meeting people across the organisation”. The Director of People and Culture stated how much he had learnt by “experiencing the different iterations and watching the flow on effect”. He also stated that while previously many people in the organisation “had been doing their best”, the program had given the organisation the opportunity of “alignment of activities”. The reflective practitioners also commented that working with academics had given them the confidence to consider expanding the program and share the key learnings with other health services across the country and even other sectors.

The pracademic was an insider and an outsider, for her a key learning in this process was the challenge of having conflicting roles. This included the role of an academic researcher, a board member in the organisation and a mentor in the project leading to a conflicting role within the organisation between governance and operations.

As a mentor one of my mentees faced a situation as part of her project which was challenging. I was concerned that by giving advice on how to handle this situation I was crossing the line as a board member into operations. My key learning is around the importance of confidentiality, transparency, insight, building trust and understanding role boundaries.

She also commented on her relationships with the two academics and noted that she had spent time explaining key contextual factors such as history, strategy and workforce challenges that they needed to be aware of. The pracademic was also positive about the evaluation methods.

You don't always know where it will lead so all avenues need to be considered. An action research approach underpinned by co-design provides an opportunity for everyone to understand and consider all factors in the evaluation process. Moreover, the insider/outsider perspective adds value by giving further insight.

For all three groups in the Evaluation Team, an appreciation of common goals and a commitment to active engagement was crucial.

In this discussion, we identify three key learnings in relation to successful impact in HRM activities and interventions by drawing insights from our findings. The first is the value of authentic academic/practitioner partnerships (Lau et al., 2025). In this case study the academics were invited into the organisation and the co-design approach meant that there was collective ownership of the evaluation process, a critical element that underpins successful co-design (Mucheru et al., 2024; Slattery et al., 2020).

The practitioners were more than stakeholders; they were partners demonstrating real commitment to the evaluation of the project. Furthermore, they had excellent access to the participants, an openness to the early findings and innovative thinking about the future of the program and its far-reaching impact. The insider/outsider (pracademic) acted as a boundary spanner keeping open communication channels, creating trust between all parties and building relationships. This paved the way for open and honest discussions and reflection on individual motivations and consolidated unified common goals (Nic Giolla et al., 2022). The pracademic's extensive experience, expertise and ongoing involvement in leadership roles in both academia and the CHRH board enabled her to bridge the gap between theory and practice and to be a mentor to the Academic Team members. This also helped in create a safe climate enabling ongoing reflection of outcomes and impact for everyone, averting the power imbalance which is often an impediment to effective co-design (Del Gaudio et al., 2020; Iniesto et al., 2022; Stacey and Wilson, 2014).

The second key learning is in relation to action research. In action research we often think in terms of an iterative process – moving forward in a linear fashion (see, Bleijenbergh and Bondarouk, 2021). However, organic processes, which included ad hoc meetings and conversations and the addition of new elements such as focus groups of line managers, that were not included in the initial Action Plan, meant that impact was often lateral and horizontal and led to outcomes that had not been considered. Through open dialogue and a conducive climate, we were able to avert challenges such as conflicting goals and potential power imbalances that significantly hinder the success of action research interventions in healthcare (Young et al., 2015).

Finally, insider/outsider research provides an opportunity for deep engagement with an organisation and many of the people within it. Brannick and Coghlan (2007) argue that an important part of insider research is the role that the organisation plays by having a stake in the research. An insider has greater access to data and networks as well as the advantage of “lived experience” and the tacit knowledge that includes. However, there are challenges for example, the difficulties of managing organisational politics and the power struggles that can take place particularly if the research generates critical findings (Coghlan and Hoolian, 2023). Other challenges identified by Morgan (2006)include role clarity, transparency, confidentiality and recognition of power relationships all of which were experienced by the pracademic in this project. However, we found that an insider/outsider research partnership can create an ambience for learning to take place naturally and spontaneously, that in this case became an unplanned benefit beyond the expected outcomes of the project. Furthermore, the pracademic, reflective practitioner, and impact focused researcher composition augments learning through diversity of thought. While it has been established that core strength in co-design is harnessing diverse knowledge (Iniesto et al., 2022), we experienced that the process can enhance knowledge and personal growth transcending the project. The process we followed enabled us to overcome knowledge transfer and knowledge production challenges that often result in failed practitioner researcher partnerships (Paauwe and De Voorde, 2025). Therefore, we argue that co-creation of knowledge and deep learning from one another to be key determinants of successful researcher practitioner partnerships.

Overall, we argue that our unique approach creates more effective research partnerships (Lau et al., 2025) and enables co-creation of knowledge and successful two-way knowledge transfer (Paawe and Van De Voorde, 2025).

Our study offers both a methodological contribution to the HRM literature and has practical implications for the healthcare industry and HRM practitioners. Our methodological framework drew on organic action research, a unique co-design team (impact focused academics, reflective practitioners and a pracademic), and co-constructed and collaborative autoethnography (see Grenier and Collins, 2016). This framework extends these approaches into HRM studies enabling effective research partnerships with practitioners (Lau et al., 2025) leading to successful knowledge production and knowledge transfer (Paauwe and Van De Voorde, 2025). Using autoethnography we applied Lau et al.'s (2025) typology of impact driven academics, pracademics and reflective practitioners and demonstrated the value of capturing these diverse perspectives. We also highlighted the critical role played by pracademics in creating an ambience of trust where all members feel safe to communicate openly and work collaboratively.

Moreover, our approach contributes to evaluation design in several ways. Our co-designed evaluation framework and Action Plan involved multi-stakeholders at both design and evaluation stages, an integral element that is largely neglected in training evaluation (Langmann and Thomas, 2019). Involvement of key organisational stakeholders representing leadership and operational functions in developing the framework enables the identification of unexpected outcomes and impact. Overall, we expect that our evaluation approach which draws data from trainees, coaches, mentors, line managers and the leadership team will identify long term impact and outcomes including behaviour changes, and performance enhancement that are critical in evaluating training effectiveness but challenging to measure (Langmann and Thomas, 2019).

For the practitioners, academic thinking encouraged them to reflect on their ideas and experiences and opened up new possibilities for the development of the program and the organisation. This can help improve the quality and credibility of the evaluation, its findings and impact. Our publications, seminars and teaching which the practitioners have contributed to, will also help share this knowledge to the greater community to extend the impact of this project and potentially help address the key challenges faced by the rural health workforce. This experience can also open new opportunities for large scale research projects offering useful solutions to the attraction and retention problems in the industry especially in regional and rural Australia.

Finally, our unique approach has greater potential outcomes by learning and sharing knowledge, bridging gaps between academia and industry and in building leadership capabilities in the rural health sector to improve not only recruitment and retention but also employee engagement and wellbeing. We know that rural communities can benefit from a high-quality healthcare system underpinned by a resilient workforce. We argue that our approach can create successful knowledge production and transfer from diverse perspectives and lead to new strategies, policies and practices to address key challenges facing the rural health sector.

Our study is limited to one organisation (CHRH) and program (PLiRH). We invite future researchers to explore comparative case studies using multiple cases and contexts. Although we employed a robust and integrated approach to data collection and analysis, the process and findings are still not immune to the usual criticisms of autoethnography, i.e. bias and generalisability issues (see Grenier and Collins, 2016). Moreover, the data were collected at the early and mid-stages of the PLiRH program. Therefore, the reflections are based on the experiences of participants during a limited period. This research may benefit from further reflections from participants at the end of the program and a longitudinal study to yield more nuanced findings. This study was conducted while the training evaluation tool was being developed. We anticipate that a robust evaluation tool that helps measure the effectiveness of leadership training encompassing outcomes and impact to individuals, to the organisation, to clients and the community will evolve at the conclusion of the project. Therefore, during the current study, we were constrained from ascertaining the overall potential of the project.

Our study revealed that a methodological framework informed by an organically co-designed, non-linear action research and an autoethnography approach is useful in HRM research and practice. The findings revealed that effective co-design involving impact driven academics, reflective practitioners and pracademics results in multifaceted stakeholder, organisational and community benefits far beyond the envisaged outcomes and impact of the project. Finally, to our knowledge, this is the first study that utilises individual and collaborative autoethnography based on reflections and narratives of academics, practitioners and pracademics involved in a co-designed HRM project. Our study offers a robust research design that helps bridge the gap between theory and practice. We believe that our study is valuable for HRM practitioners for evidence-based practice through impactful collaboration with academics.