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Health systems worldwide are hampered by disconnects between governance, management, and operations, which negatively impact on their ability to deliver efficient, effective, and safe healthcare services. This paper shows how insights from the Viable System Model (VSM) can help us to conceptualise health system disconnects impacting specialist clinical services and develop solutions to address organisational fragmentation.

A case study of a specialist clinical service was undertaken, where the VSM was used to guide semi-structured interviews and workshops with clinicians and managers and analysis of findings.

The VSM provides a coherent way to conceptualise the disconnects and identify their structural underpinnings. Three novel organisational pathologies emerged from the study.

This New Zealand-based study was undertaken during the COVID-19 pandemic and a period of major health system reform, introducing uncertainty into service provision that may have impacted stakeholders’ views.

The three novel pathologies affect how health systems define their services, their understanding of the management function, and the importance of coordination. The resulting clarity of functioning could improve service quality, staff and patient satisfaction, and the effectiveness and efficiency of healthcare service delivery.

This study contributes to the VSM literature on organisational pathologies by providing three novel pathologies for a perspective that may be useful beyond healthcare and invites consideration of health system disconnects as a coherent field of study.

Intersectionality addresses complex avenues of oppression that emanate at the intersections of one’s identities. However, the intersectional framework assumes static identities, which are increasingly being acknowledged for their fluidity. This research explored the extent of the fluidity of social identities to draw implications for the application of the framework in research.

27 participants from a post-graduate elective course on diversity and inclusion identified their significant social identities, and submitted a write-up using hermeneutic phenomenology in which the participants shared their lived experiences of the fluidity of their social identities in different spaces they occupy or find themselves in.

Fluidity-triggering stimuli in different environments and their associations with identity-related motives were uncovered using thematic analysis. Stimuli operating at micro-, meso- and macro-levels rationally explained identity fluidity. However, in addition to types, intensity and frequency of stimuli, psychological factors, such as identity status, were decisive in determining the degree of generalization of stimuli across individuals and spaces that significantly influenced identity fluidity.

This research explored the extent of the fluidity of social identities to draw implications for the application of the intersectional framework in research. The findings contribute to future research by identifying limitations of the intersectional framework based on the fluidity of social identities arising from environmental stimuli that operate at micro-, meso- and macro-levels, and the extent of psychological generalization of these stimuli across spaces.