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This paper draws on the metaphor of “magic” to explore the role of dialogue conferences and subsequent activities as a tool for organizational development and change. The metaphor is introduced and elaborated as a means of allowing critical reflection on action research projects.

In the empirical setting of a change project in a regional health authority in Sweden, researchers designed and facilitated a development coalition for introducing integrated care. This required an action research intervention that supported the establishment of new relationships and developmental practices across both organizational and professional boundaries.

The unfolding of developmental processes set in train by dialogue conferences are shown as being a dynamic process of magic underpinned by the principles of democratic dialogue.

By drawing attention to the three keywords of development, participation and dialogue three sites have been identified for critical reflection and reflexivity in action research. Magic is argued as an activity wherein the seemingly impossible is made to happen in these areas; equally it can be an activity of simple illusion whereby appearance is at odds with reality.

This chapter examines the developmental journey toward a sustainable healthcare system in the west of Skaraborg County in Sweden from 2000 to 2010. It tracks a stream of collaborative research projects within the context of the Swedish sustainability debate that were focused on achieving improved care quality, patient safety, efficiency, and efficacy. The case reports how a central government directive to integrate healthcare at the local level – the county – led to the establishment of a development coalition management group that designed and managed the transformation via broad participation and engagement mechanisms. The transformation process toward a more sustainable healthcare system raises theoretical and practical questions about sustainable effectiveness, the role of partizcipation and learning mechanisms such as democratic dialogue conferences in sustainable effectiveness, the tension between planned and emergent change processes, and the challenge of integration in the drive toward a sustainable healthcare system.