Public healthcare is a complex environment characterized by overlapping professional domains, distributed authority, and continual reform. Projects, while intended to drive innovation and adaptation, are often managed in isolation. This fragmented approach leads to duplicated efforts, misaligned priorities, and missed opportunities for strategic coherence. Despite growing interest in project portfolio management (PPM), effective tools for handling interdependencies and systemic complexity remain scarce.

This thesis explores how multi-project environments in public healthcare can be better organized through a complexity-informed, strategic perspective. It integrates theory on project, program, and portfolio management (P3M), organized complexity, and professional organizations. The research employs a participatory action research (PAR) methodology, working closely with Region Halland and other Swedish public healthcare bodies.

Three longitudinal case studies were conducted:

VAS+, a complex hospital IT project, where DSM and DMM tools were used to restructure subprojects and improve coordination.

NPÖ, involving seven organizations, where shared work packages were identified to enable joint planning and reduce duplication.

KFP, a hospital-wide portfolio of 21 projects, where DSM mapping supported the creation of program structures and a governance function.

These cases highlight the limitations of traditional top-down PPM approaches in complex adaptive systems. Instead, the research supports a bottom-up method using DSM and DMM to map dependencies and enable strategic coordination.

A Strategic SOP Framework was developed to guide managers in navigating multi-project complexity. It emphasizes acknowledging interdependencies, applying suitable tools, aligning projects with strategic goals, and adapting to institutional contexts.

The thesis advocates a shift from control to coordination and from isolated planning to strategic participation, offering a new model for managing change in complex healthcare settings.