Theorizing Governance Paradoxes: Insights From a Longitudinal Case Study of a Major Healthcare Partnership

Scholars often frame governance as fraught with paradoxes. However, few have harnessed recent advances in paradox research to theorize governance paradoxes. This study addresses that gap by developing an empirically based conceptualization of governance paradoxes. It is derived from a 10-year case study of a major healthcare partnership, investigated qualitatively through document analysis and interviews. Existing literature primarily treats governance paradoxes as something puzzling or focuses on only one aspect of the two definitional characteristics of paradoxes: the tensions and the responses. We extend a dual framework that examines the tensions defining key governance demarcations in organizational purpose and decision structures, as well as the patterns of decision-makers’ responses, which evolve in response to crises and environmental shifts. This approach extends the scholarly conversation on governance through the lens of paradox and may help enhance decision-makers’ understanding of and engagement with complex governance dynamics.