Studying complexity in health services research: desperately seeking an overdue paradigm shift

Complexity is much talked about but sub-optimally studied in health services research. Although the significance of the complex system as an analytic lens is increasingly recognised, many researchers are still using methods that assume a closed system in which predictive studies in general, and cont...

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Bibliographic Details
Published in:BMC medicine 2018-06, Vol.16 (1), p.95-95, Article 95
Main Authors: Greenhalgh, Trisha, Papoutsi, Chrysanthi
Format: Article
Language:English
Subjects:
Analysis
Causality
Community support
Complexity
Complexity (Philosophy)
Councils
Ethnography
Health services
Health Services Research - methods
Healthcare
Humans
Intervention
Management
Medical care
Medical research
Medicine
Methodology
Public health
Systems thinking
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Summary:Complexity is much talked about but sub-optimally studied in health services research. Although the significance of the complex system as an analytic lens is increasingly recognised, many researchers are still using methods that assume a closed system in which predictive studies in general, and controlled experiments in particular, are possible and preferred. We argue that in open systems characterised by dynamically changing inter-relationships and tensions, conventional research designs predicated on linearity and predictability must be augmented by the study of how we can best deal with uncertainty, unpredictability and emergent causality. Accordingly, the study of complexity in health services and systems requires new standards of research quality, namely (for example) rich theorising, generative learning, and pragmatic adaptation to changing contexts. This framing of complexity-informed health services research provides a backdrop for a new collection of empirical studies. Each of the initial five papers in this collection illustrates, in different ways, the value of theoretically grounded, methodologically pluralistic, flexible and adaptive study designs. We propose an agenda for future research and invite researchers to contribute to this on-going series.
ISSN:1741-7015
1741-7015
DOI:10.1186/s12916-018-1089-4