Internationally educated nurses and midwives account for 23.8% of the UK nursing and midwifery workforce, making the barriers relevant to a substantial group of professionals whose prior experience may be underused. The review, published in Frontiers in Health Services in 2026, included studies of internationally educated nurses and midwives registered with the Nursing and Midwifery Council and working in UK healthcare settings. The authors searched CINAHL, MEDLINE, PubMed, the Cochrane Library and Embase for literature published from January 2005 to March 2025.

They also examined grey literature, searched Google Scholar and checked reference lists. Methodological quality was assessed with the Joanna Briggs Institute qualitative checklist and the Mixed Methods Appraisal Tool. Quantitative results were converted into narrative descriptions, or “qualitised data,” before being integrated with qualitative findings through the Joanna Briggs Institute’s convergent approach, allowing numerical patterns and reported experiences to be considered together.

Eight articles met the inclusion criteria: five were predominantly qualitative and three used mixed methods. Six examined internationally educated nurses, one examined internationally educated midwives and one included both professions. The studies represented approximately 1,745 nurses and seven midwives from countries including Nepal, Ghana and European Union nations, as well as regions across the Middle East, Africa, Asia and Australasia.

Settings included NHS hospitals and trusts, healthcare education organisations, higher education institutions and other parts of the UK healthcare sector. The imbalance is important because most large quantitative datasets concerned nurses, limiting what can be concluded specifically about midwifery or compared statistically between nursing and midwifery. One of the clearest quantitative findings concerned movement through NHS pay bands.

Pressley and colleagues reported a median time to promotion of 6.8 years for internationally educated nurses, compared with 5.8 years for UK-trained colleagues. Fewer internationally educated nurses in that study progressed beyond Band 6. Qualitative accounts supplied context for this difference.

Participants described promotion pathways as unclear and insufficiently transparent, while managerial discretion, interview preparation, patronage and subjective assessments of leadership potential could influence who was considered ready for senior roles. Inequalities in access to organisational knowledge, feedback and endorsement meant that the visibility of formal criteria did not necessarily produce equal access to promotion. The evidence therefore documents a difference in progression between the groups studied, rather than establishing a universal rate across the entire UK workforce.

The synthesis produced five interconnected themes: career progression and structural barriers; early-career scaffolding and development support; skill mismatch and de-skilling; mentoring, sponsorship and leadership access; and organisational culture and inclusion. A barrier was defined as a structural, institutional, social or individual factor that obstructed or delayed access to progression, professional development or leadership. A facilitator enabled or accelerated those processes.

Some factors could operate in both directions: supportive line management, continuing professional development and structured induction facilitated progression when consistently available, but became barriers when absent, limited or selectively allocated. This distinction shows why an isolated programme may not remove disadvantages embedded in wider promotion and workforce systems. Early-career support emerged as a particularly important influence.

Structured induction helped internationally educated professionals understand NHS expectations, while supportive line managers facilitated learning, feedback and integration into professional networks. Career-development conversations helped staff identify existing expertise and understand routes into advanced roles, but these discussions were not routinely embedded in the first years of employment. In one mixed-methods study, fewer than half of respondents had participated in formal career-development conversations during their first two years.

Annual appraisals and informal discussions often did not provide sufficient guidance, leaving some internationally educated staff uncertain about their prospects. Equitable continuing professional development was associated in the synthesised evidence with stronger confidence, professional identity, career commitment and intentions to remain, whereas restricted access contributed to dissatisfaction and skill underuse. Recognition of prior competence was another central theme.

Qualitative studies described internationally educated professionals entering roles that did not make full use of their clinical knowledge, qualifications or leadership experience. Nepali nurses recruited to residential care homes reported being assigned routine personal care and catering tasks during adaptation rather than clinical nursing work that matched their expectations. Participants associated these experiences with skill underuse, reduced confidence and erosion of professional identity.

Other studies found that overseas qualifications and previous experience were undervalued in NHS career structures, with many internationally educated nurses remaining at Band 5 despite substantial prior experience. The synthesis interprets these observations in relation to recruitment, deployment and competence-recognition practices, rather than as evidence that individual professionals lacked capability. Mentoring and sponsorship appeared in the review as complementary but distinct forms of support.

Mentoring provided guidance, encouragement, reflective learning, organisational knowledge and confidence, helping internationally educated professionals navigate unfamiliar career systems. Sponsorship involved senior colleagues actively advocating for individuals, creating opportunities and increasing their visibility within organisational networks. Leadership programmes that incorporated sponsorship and inclusive leadership increased confidence and created opportunities for career progression.

Internationally educated nurses who advanced into leadership positions also became visible role models and sources of support for colleagues. Yet the review found that mentorship alone was insufficient where sponsorship, transparent promotion criteria and equitable development opportunities were absent. Selectively distributed informal sponsorship could also reproduce the advantages already enjoyed by other staff groups rather than widen access to leadership.

Organisational culture connected formal systems to everyday professional experience. Inclusive leadership, psychological safety and a sense of being valued were associated with confidence, teamwork, engagement, wellbeing and stronger organisational commitment. Practical support involving peer relationships, housing, family circumstances and financial security also influenced integration and intentions to remain.

Conversely, bias, favouritism and exclusion weakened confidence and could discourage internationally educated staff from seeking feedback or applying for promotion. Participants in one study described becoming so demoralised by perceived discrimination that they withdrew from career development, stopped applying for promotion and experienced career stagnation. These findings do not establish that workplace culture alone causes retention or progression, but the convergence of quantitative patterns and qualitative accounts indicates that organisational practices shape both the availability of opportunities and staff members’ willingness to pursue them.

Leadership development programmes offered benefits, but the evidence indicates that they could not independently remove broader structural barriers. The findings must be interpreted within a small and uneven evidence base. Only eight studies were included, some provided limited detail about researcher positionality or analytic procedures, and several date from periods before major changes in NHS workforce and migration policy.

The 2005–2025 search window also spans the Equality Act 2010, the NHS People Plan, changes associated with the post-COVID recovery and other workforce reforms, making direct comparisons across time difficult. Quantitative evidence for internationally educated midwives was especially sparse, and the available data did not permit statistically meaningful comparisons between professions or between NHS and private-sector settings. The review therefore identifies recurring barriers and facilitators across the studies included, while leaving their frequency and uniformity across every organisation, profession and career stage uncertain.

Its policy implications connect transparent promotion pathways, recognition of international competence, equitable development access, mentoring and sponsorship within broader workforce systems rather than treating any one as a stand-alone solution.

Subject of Research: Systematic review of career progression and leadership barriers among internationally educated nurses and midwives in the UK

Article Title: Barriers and facilitators to career progression and leadership among internationally educated nurses and midwives in the UK: a mixed methods systematic review

Article References: Sagoo, R., Merriman, C., Mukherjee, T., Gondo, N., & Baldwin, S. (2026). Barriers and facilitators to career progression and leadership among internationally educated nurses and midwives in the UK: a mixed methods systematic review. Frontiers in Health Services, 6, Article 1854601. https://doi.org/10.3389/frhs.2026.1854601

Image Credits: AI Generated

DOI: 10.3389/frhs.2026.1854601

Keywords: internationally educated nurses, internationally educated midwives, career progression, healthcare leadership, NHS workforce, promotion inequity, professional development, mentorship and sponsorship, de-skilling, organisational culture, systematic review, Barriers

The programme, known locally as the Quality Safety Culture Framework (QSCF), was built on practice development—a participatory approach to workforce transformation that uses facilitation, active work-based learning, and critical inquiry to change workplace cultures from within. Unlike conventional quality improvement, which typically targets individual units or specific safety problems, the QSCF aimed at something far more ambitious: building the capability of frontline teams to generate, lead, and sustain improvement from the point of care across an entire hospital. It was explicitly designed as what organisational researchers call “help it happen” rather than “make it happen”—practitioner-led and participatory, with organisational leaders playing an enabling rather than directive role. Its components included daily safety huddles in every setting, quality and safety boards in every work unit, a Clinical Leads facilitation programme supporting roughly 185 clinicians across eight high-risk domains, audits aligned to national safety standards, and an annual hospital-wide Safety Attitudes Questionnaire with facilitated unit-level feedback.

The research team, led by Jacqueline Peet of the University of the Sunshine Coast and Clint Douglas of Queensland University of Technology, conducted 27 interviews with nursing, medical, allied health, and executive staff, six half-day workshops with 49 frontline staff, a multidisciplinary focus group, and approximately 20 hours of observation, all during the programme’s sixth year. Their analytical approach was deliberately abductive: rather than testing predetermined assumptions, they treated the fieldwork as a critical dialogue partner designed to generate theoretical surprise. Four tentative programme theories—formulated as if-then propositions about evaluation, engagement, facilitation, and leadership—were developed before analysis and then challenged, extended, or reframed by the evidence. The central analytical question that emerged was stark: why does the same programme, under the same governance conditions, produce sustained participatory improvement in some settings and mere directive compliance in others?

The answer, distilled into five refined programme theories, begins with data. The researchers found that the evaluation infrastructure itself—huddles, boards, audits, surveys—was not the active ingredient. What mattered was how data connected to a learning-oriented culture. When experiential data such as patient stories and qualitative feedback sat alongside quantitative metrics, transparency enabled collaborative learning. When performance numbers dominated, the same transparency became surveillance. One clinical leader who discovered that only 1.3 percent of discharged patients had an advance care plan spent two months asking “why, why, why?” rather than jumping to a solution, traced the problem back into residential aged care facilities, and built an interdisciplinary collaboration that raised completion rates to 21 percent within six months. On another ward, staff noticed falls clustering around 7 a.m., connected this to morning medication timing, changed the schedule, and triggered a hospital-wide change to the medication system’s default settings—insights that no standardised falls-prevention protocol could have prescribed.

The second theory concerns communicative space, and here the evaluation produced one of its most striking findings: such space must already exist before facilitated reflection can produce its theorised outcomes. In a large procedural department with 200 full-time staff, values clarification sessions prompted colleagues who had worked side by side for years to finally discuss why they chose their professions and what mattered to them—leaving an emotional impact still vivid two years later. When pressure to maximise procedural volume later threatened safety, staff drew directly on their shared vision statement: “we come to work to provide the best quality and safe care, not the numbers.” By contrast, in settings where trust and relational safety had not been established, safety huddles devolved into one-directional information transfer. “Is it truly a safe space, or are we (just) saying it?” one participant asked, noting that sometimes only department heads speak out because “you don’t want to rock the boat.” Power hierarchies, the researchers concluded, are not flattened by facilitated forums alone.

The third theory exposed the study’s most consequential finding: systematic implementation drift concentrated in the programme’s facilitation pipeline. The educators, mentors, and clinical leads who translate programme intent into ward-level practice were trained primarily in quality improvement methods—audit, Plan-Do-Study-Act cycles, pre-post surveys, education-as-intervention—and transmitted what they knew. Observed clinical leads workshops focused on templates and “showing an effect” rather than collaborative reflection. A patient safety representative noted clinical leads’ “strong desire to jump to solutions rather than to sit and brainstorm.” Crucially, the researchers argue this drift was not a design failure or a matter of individual choice but a fidelity problem driven by organisational logic: quality improvement produces measurable outputs that governance systems demand, while practice development produces relational and cultural outcomes that are harder to quantify and easier to defer. The educators were transmitting what the system rewards.

Where the participatory intent was realised, the pattern was recognisable. In a dialysis unit, a clinical lead tackled advance care directive conversations—a challenge no protocol could resolve—through months of inclusive, collaborative inquiry, with staff released from the floor to attend workshops. In community health, a lead formed a working group across dispersed teams and deliberately chose not to delegate: “I want the staff to feel well supported when they raise issues or concerns, so they got listened to.” Staff designed their own educational resources and visual cues, cutting unnecessary glove costs by 40 to 50 percent and embedding the project into the service’s business plan. Notably, some advanced practice nurses were surprised to discover that facilitation skills mattered more than their subject knowledge when mentoring—confirming that the active ingredient is the facilitative relationship, not the clinical content.

Leadership emerged as the fourth condition, but with a caveat that should concern hospital executives everywhere. What sustained the programme was not person-centred leadership in the abstract but mutual trust and vulnerability between leaders and teams—honestly sharing constraints, being transparent about what is and isn’t possible. A nursing co-director who spotted a shared pattern of rising falls and pressure injuries across two very different wards brought the teams together, presented the data, and then stepped back: “the ideas came from them.” Yet the researchers found these conditions were consistently person-dependent rather than system-embedded. Culture maps had to be restarted when staff turnover made original visions irrelevant, and one nursing unit manager admitted starkly: “none of this is done by the RNs … it’s mostly me.” The programme was vulnerable at every leadership transition.

The fifth theory, new to this evaluation, addressed a quieter threat: project proliferation and improvement fatigue. Participants described running four different projects on a ward simultaneously, completing surveys out of hours, and receiving duplicate templates to tick monthly. “Push, push, push, no-one engages because they don’t understand how it all works together,” one participant explained. Against this backdrop, an acute aged care unit caring for long-stay patients with dementia initiated a “Rise and Shine Breakfast Club”—staff sitting down to eat with patients three times a week, with real cutlery and soft music. Patients who had refused to leave their rooms were among the first at the table; some began eating independently for the first time in years; falls reduced. The initiative used quality improvement tools, but its purpose was irreducibly person-centred, and it spread to a neighbouring ward organically. Collaborative prioritisation, the researchers argue, is not merely a recommendation to do fewer projects—it is itself a participatory act: when teams decide together what matters most, practice development is enacted in the very act of prioritising.

The study’s conclusion is sobering and practical in equal measure. Organisational enablement—naming, backing, resourcing, and connecting local improvement—is necessary but insufficient to sustain participatory practice. Even with genuine participatory design intent, governance infrastructure built to reward measurable outputs can systematically displace the relational and cultural processes that make improvement durable. Huddles can become checklists, boards can become wallpaper, and clinical leads can become auditors, all while satisfying accreditation. For hospital leadership teams, the five refined programme theories offer a diagnostic: attend to what facilitation actually transmits, value experiential alongside quantitative evidence, actively prioritise and sequence improvement demands, build dialogue spaces as a way of being rather than an intervention, and embed participatory principles in systems rather than individuals. The Director of Nursing’s founding question—how do you know the care in this hospital is safe and person-centred?—can now be answered. The harder lesson is that keeping the answer alive requires defending the conditions that produced it, year after year, against the gravitational pull of compliance.

Subject of Research: A qualitative process evaluation of a hospital-wide practice development programme for quality and safety improvement

Article Title: How is practitioner-led quality and safety improvement sustained across a whole hospital? A process evaluation of a practice development programme

Article References: Peet, J., Tuqiri, K., Smoother, R., Sheppard-Law, S., & Douglas, C. (2026). How is practitioner-led quality and safety improvement sustained across a whole hospital? A process evaluation of a practice development programme. Frontiers in Health Services, 6, Article 1932480. https://doi.org/10.3389/frhs.2026.1932480

Image Credits: AI Generated

DOI: 10.3389/frhs.2026.1932480

Keywords: practice development, quality improvement, patient safety, safety culture, nursing leadership, facilitation, process evaluation, hospital care, participatory approaches, health services research, organisational culture, workforce capability

The research team, led by Suzanne Johanson Sturesson of the University of Gothenburg, set out to investigate what women in menopause experience as supporting and hindering factors in their work environment. The motivation is grounded in stark statistics. At the end of 2024, the Swedish Social Insurance Agency reported 201,462 ongoing cases of sickness benefit, and women constituted 65 percent of them. Within that cohort, 28 percent were aged between 50 and 59, roughly the age at which menopause typically arrives in western countries, where the average age of the transition is 50 to 51 years. The predominant reasons for sick leave were psychiatric diagnoses, including fatigue syndrome and depression, while musculoskeletal diagnoses were notably more prevalent among those aged 50 to 59.

Although women in menopause can end up on sick leave because of severe symptoms, reliable statistics on how many absences are actually driven by menopause are difficult to obtain, since the same symptoms can stem from other causes. What is well established is the dose-response relationship: research shows a negative correlation between the severity of menopausal symptoms and work ability, meaning that as symptoms intensify, the capacity to work declines and the risk of sick leave rises. Studies have also found that up to one in four women report severe menopausal symptoms, and that symptoms negatively influence women’s self-rated productivity. Some women respond by temporarily reducing their working hours, even while worrying about the consequences for their careers. Others practice presenteeism—working despite diminished capacity—which carries substantial risks, including long-term impairments in work ability.

To capture the lived experience behind these numbers, the researchers used a qualitative design with an inductive approach, conducting semi-structured interviews with six women aged between 46 and 58 who were active in the Swedish labour market with employment rates of at least 50 percent and who reported at least one self-perceived symptom linked to menopause. Participants were recruited through targeted sampling from a closed Facebook forum called Stark genom klimakteriet—Strong through menopause—with roughly 13,000 members. Four of the six women were undergoing menopausal hormone therapy at the time. Five worked full-time and one part-time, and their workplaces spanned occupational health, primary health care, industry, state-level academic activities and municipal administration. Five interviews took place digitally and one physically, each lasting between 39 and 79 minutes, and the transcripts were analysed using qualitative content analysis according to Graneheim and Lundman.

The analysis yielded two main categories: the necessity for enhanced awareness and education regarding menopause, and adaptations and recovery opportunities in the work environment. The first category describes how a general lack of knowledge about menopause ripples through organisations, social spaces and individuals. Several informants initially lacked knowledge about menopause altogether, which led to unrecognised symptoms and increased suffering, including sick leave due to exhaustion and depression. Only through personal insight and their own research did they come to understand that their symptoms were menopause-related, and only after making changes or starting hormone therapy were they able to resume working. One informant described the anxiety plainly: feeling insecure about both her body and her mind created stress when she feared she might not be able to cope with her job.

The study also documented a heavy stigma. Several informants felt that menopause was treated as something that should simply pass by unmentioned, and they found it uncomfortable and embarrassing to raise the topic with human resources or their managers. Being treated with understanding, it turned out, was largely a matter of chance—hinging on whether managers happened to have personal experience of menopause. One participant described the relief of having a boss in the same situation, which removed stress and pressure. Where workplaces lacked forums for disseminating information about health issues, women were forced to advocate for changes themselves, a burden that was particularly heavy during periods of reduced energy. Not being believed by a manager when describing symptoms left informants feeling diminished.

The second main category mapped the concrete adjustments that made work sustainable. Flexibility emerged as central: the ability to take a break when needed, visit the toilet, regulate emotions, interrupt work for shorter rests, or work at times of day when they felt alert. Organisations that failed to offer this flexibility were perceived as obstacles. The physical environment cut both ways. Too few toilets, dark spaces, workplaces that increased sedentary time, poor ergonomics and poor seating were hindrances, while bright light, height-adjustable desks, exercise bikes and standing mats supported the increased need to move. Cognitive symptoms—mental fatigue and difficulty focusing—made stimulus-heavy open offices punishing. One informant recounted how, with a brain exhausted by concentration difficulties, she could never have coped with twenty people talking, drawers banging and phones ringing all at once; a separate or closed room was perceived as a decisive support.

Recovery opportunities proved equally important. Mindfulness and short breaks in peace and quiet helped informants balance mood during stress attacks and worrying, but the lack of a physical place for such recovery was described as an obstacle. Working from home was repeatedly praised as a valuable adjustment: it made necessary breaks easier, increased sleep by removing commutes, and, as one informant noted, made work more efficient. The social environment, meanwhile, functioned as a powerful buffer. Safe relationships with close colleagues allowed women to be open about how they felt, which created security, improved well-being and even increased performance. One informant described how a colleague’s openness about her own menopausal symptoms made it easier for everyone in the group to admit being exhausted after a bad night. Conversely, the absence of an open atmosphere left women feeling alone, which made them feel worse than their symptoms alone warranted.

The authors interpret these findings through the Model of Human Occupation, which explains how individuals generate and modify actions through interactions with their social, institutional and physical environments, and through the concept of occupational adaptation—modifying one’s performance or environment when abilities change. Resilience, in this framing, rests on three components: knowledge of the change, skills to solve the problems that arise, and surrounding support. All three appeared in the data. The researchers also frame the results in terms of menopausal health literacy, arguing that the suffering described by participants could have been reduced had they received support to understand their condition earlier. Because health literacy depends on context, the authors argue it is a societal issue—not merely an individual or healthcare concern but essential in the work environment as well.

The study’s conclusions carry practical weight for employers. Individual adaptation is crucial because the impact of the work environment is personalised, but awareness and knowledge about menopause, together with an open and flexible organisational culture, facilitate the necessary adjustments. Recognising the social environment as a supportive factor is essential, and occupational therapy interventions that consider the individual in relation to the workplace can contribute to sustainable change. The authors emphasise a preventive approach: since menopause is a transition rather than an illness, workplace adjustments should aim to stop symptoms from developing into ill-health and future sick leave. The researchers acknowledge limitations, including the small sample of six informants, recruitment through a forum whose members may have had more severe symptoms, and a sample dominated by office-based work, which limits transferability. They call for further research into menopausal women’s experiences in welfare and service professions, and into the incentives and obstacles employers face in implementing the changes women say they need. With women making up nearly two-thirds of Sweden’s ongoing sickness cases, the message from this study is difficult to ignore: the work environment is not a backdrop to menopause—it is an active force in determining whether women in midlife stay well and stay working.

Subject of Research: The impact of the work environment on work ability in women experiencing menopause

Article Title: Women’s experience of the impact of work environment during menopause – A qualitative interview study

Article References: Johanson Sturesson, S., Löfgren Bergérus, M., Arvidsson, L., & Andersson, C. (2025). Women’s experience of the impact of work environment during menopause – A qualitative interview study. Scandinavian Journal of Occupational Therapy, 32(1), Article 2519241. https://doi.org/10.1080/11038128.2025.2519241

Image Credits: AI Generated

DOI: 10.1080/11038128.2025.2519241

Keywords: menopause, work environment, occupational health, women's health, qualitative research, work ability, workplace adaptation, occupational therapy, health literacy, stigma, organisational culture, Sweden

The starting point for the framework is a sobering observation from the change management literature: intentional change processes are frequently slow, meet resistance and fail outright, and they are a significant source of stress for employees. Scholars such as McFillen and colleagues have speculated that the failure to conduct an accurate organisational diagnosis, and the related failure to build readiness for change, plays a major role in the high rate of failed initiatives. Yet the diagnostic models most widely used in practice, including the McKinsey 7 S model, Weisbord’s six-box model and the Burke–Litwin model, have been criticised for presenting heterogeneous, atomistic categories without specifying how the factors interact, for omitting elements such as the external environment, and for lacking strong theoretical foundations. They offer managers step-by-step checklists, the authors argue, but little insight into why resistance arises or what lies beneath surface phenomena.

SyMOA is grounded in the systems psychodynamic tradition that emerged at the Tavistock Institute in London in the 1950s and 1960s. That approach combines open-systems theory, which sees organisations as self-sustaining systems in constant exchange with their environment, with Freudian and object-relations theories, which hold that unconscious processes, hidden conflicts and anxieties powerfully shape human behaviour. As researcher Yiannis Gabriel has succinctly put it, in a psychodynamic view conflict is unavoidable and constitutive of the subject. Systems psychodynamic scholars examine how organisations develop mechanisms to manage competing drives, such as the desire for change versus the desire for stability, or the need for independence versus the need for belonging, and they focus on group behaviour and the collective unconscious rather than isolated individuals. What has been missing, the Freiburg team contends, is a structured diagnostic system built directly from these insights.

To fill that gap, the authors turned to clinical practice. Their template is the Operationalised Psychodynamic Diagnosis, or OPD, a well-researched multiaxial system used in German-speaking psychotherapy that captures a patient’s psychological state across experience of illness, interpersonal relationships, life-determining unconscious conflicts and structural functioning. The OPD is typically administered through a semi-structured interview, and the resulting psychodynamic profile informs therapy planning and evaluation. The researchers stress that transferring psychodynamic concepts from the individual to the organisational level does not mean mapping intrapsychic processes onto companies. Instead, following the systems psychodynamic tradition, organisational structures, routines and relational patterns are understood as socially organised responses to anxiety, uncertainty and conflict, an abstraction of underlying principles rather than a literal transfer.

The resulting framework assesses organisations along three interrelated dimensions. The first, the organisation’s inner functioning, examines current challenges and how they are attributed, whether to technology, workforce, culture or an integrated socio-technical system, along with resources, barriers to change and organisational climate. Beneath these visible features lie the inner workings: regular, repetitive conscious and unconscious patterns through which the organisation deals with itself and the external world. These are rated across five categories, each considered both inwardly and toward the environment: internal and external awareness, regulatory capacity, communication, attachment, and organisational defence mechanisms. These workings change slowly over time and can be rated from well functioning to low functioning.

The second dimension addresses internal relational patterns and dynamics, which are shaped by organisational structure and the demands of communication, cooperation and coordination, but also by interpersonal affect and the history of shared interaction. Assessment focuses on observable relational behaviour and conscious emotional experience in specific situations, at horizontal levels such as between teams and vertical levels such as between senior management and employees. The approach explicitly captures how each party in an interaction experiences itself and the other, illuminating recurring and potentially dysfunctional patterns of relationship.

The third dimension probes the organisation’s unconscious conflicts. Just as people carry an inner experience shaped by early experiences and proven survival strategies, the authors argue, companies accumulate conflicts that begin as visible tensions between teams or managers and gradually shift inward, becoming part of the organisational DNA. Conflict here does not mean open dispute but the struggle between contradictory needs, such as how much freedom versus how much guidance, or how much responsibility versus how much security. When such basic conflicts are adequately resolved, an organisation can flex situationally between the poles of need; when it cannot, it rigidly pursues one pole, and the conflict is repeatedly activated by situational factors during the organisation’s development.

Conceptually, SyMOA is framed by a metamodern sensibility, drawing on the philosophy of Vermeulen and van den Akker, which holds modernist rigor and postmodern reflexivity in productive tension rather than resolving them. In practice this means organisational phenomena are analysed using structured dimensions while remaining open to multiple, potentially conflicting interpretations. The framework also aligns with critical theory’s project of revealing entrenched power relations: organisational culture, the authors note, can operate both as a collective social defence against anxiety, in the tradition of Menzies and Schein’s concept of learning anxiety, and as a subtle form of control in which employees internalise corporate values and police themselves. Through reification, historically contingent power relations become naturalised and appear as objective features of organisational life, resistant to critique. By surfacing hidden defences and covert emotional processes, SyMOA is intended to make these barriers to change visible and contestable.

The authors are careful to position the work as deliberately conceptual. SyMOA is not a universal or prescriptive model but one possible analytical framework, and its dimensions are conceptual categories derived from systems psychodynamic theory rather than validated measures. A companion study protocol published in JMIR Research Protocols outlines the next phases: a structured interview guide, application in instrumental case studies, and testing of intercoder reliability, construct validity, content validity and known-groups validity, with safeguards including informed consent, confidentiality, peer debriefing and triangulation to manage the ethical risks of deep, potentially sensitive inquiry. The authors also draw an analogy to psychotherapy research, where interventions succeed more often when structural aspects, relationship dynamics and conflicts are assessed in a differentiated way and matched to a client’s stage of readiness for change, from pre-contemplation through maintenance. If that logic holds for organisations, they suggest, a SyMOA profile could indicate an organisation’s readiness for change and help tailor interventions accordingly. Whether the framework can deliver on that promise will depend on the empirical studies now underway, but the ambition is clear: to give organisations a clinical-grade instrument for understanding not just what they do, but why they keep doing it.

Subject of Research: A systems psychodynamic diagnostic framework for assessing unconscious organisational dynamics

Article Title: A systems psychodynamic framework for understanding and assessing organisational dynamics

Article References: Lahmann, C., Rank, O., & Müller, A.-M. (2026). A systems psychodynamic framework for understanding and assessing organisational dynamics. Discover Psychology, 6(1), Article 272. https://doi.org/10.1007/s44202-026-00885-3

Image Credits: AI Generated

DOI: 10.1007/s44202-026-00885-3

Keywords: organisational diagnostics, systems psychodynamics, organisational change, psychodynamic theory, organisational culture, clinical diagnostics, metamodernism, critical theory, organisational psychology, change management, OPD, organisational dynamics