Response to ‘The Appropriation of Complexity Theory in Health Care’

Greenhalgh, Trisha; Plsek, Paul E.; Wilson, Tim; Fraser, Sarah; Holt, Tim

doi:10.1258/jhsrp.2010.009158

Cited by 38 publications

(43 citation statements)

References 22 publications

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“…Finally, we find the concept termed "Complex Adaptive Systems" (CAS) relevant to healthcare (Greenhalgh, Plsek, Wilson, Fraser, & Holt, 2010;Kernick, 2004;Plsek, 2001;Plsek & Wilson, 2001;Plsek & Greenhalgh, 2001;The Health Foundation, 2010). CAS offers a model for qualitative studies of persons participating in dynamic, non-linear, non-mechanical processes while maintaining sustainable groups (Mennin, 2007).…”

Section: Theoretical and Methodological Frameworkmentioning

confidence: 99%

Leadership practice as interaction in primary care emergency team training

et al. 2015

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The present study, framed as critical action research, aimed at contributing to the improvement of training emergency teams in primary care. The first author was a participating observer in local simulation sessions performed by 10 different teams. Leadership practice as interaction was analysed in three types of communicative spaces: in the review and debriefing sessions; in the author group; and in focus groups involving local stakeholders. The teams practiced both designated and distributed leadership in the course of the various training sessions. During the simulation sessions, the teams remained aware of the physicians' formal responsibility for decisions concerning diagnosis and medication. Shifts in leadership modes coincided with situational changes requiring particular competencies. Distribution of leadership and

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Section: Theoretical and Methodological Frameworkmentioning

confidence: 99%

Leadership practice as interaction in primary care emergency team training

et al. 2015

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“…Asserting that ‘it is imperative to get it right’, he cautioned that ‘although it is appealing to envision that chaos somehow affords an explanation for the complexities we observe in the world around us (particularly if we use it as a metaphor by which to explain occurrences in education), chaos as a physical theory has some very specific conditions’ . Both Paley and Norman drew attention to the need for scholars using complexity science to define their terms carefully. Further, because they viewed complexity science as singular – for Paley a mathematical science and for Norman a physical science – both authors asserted a single correct way to use those terms.…”

Section: What Are the Implications Of This Use?mentioning

confidence: 99%

“…Responding to these accusations that they had used complexity science illegitimately, Greenhalgh et al . and Regehr both agreed that precision of terms is important.…”

Section: What Are the Implications Of This Use?mentioning

confidence: 99%

What is the state of complexity science in medical education research?

2018

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Context ‘Complexity’ is fast becoming a ‘god term’ in medical education, but little is known about how scholars in the field apply complexity science to the exploration of education phenomena. Complexity science presents both opportunities and challenges to those wishing to adopt its approaches in their research, and debates about its application in the field have emerged. However, these debates have tended towards a reductive characterisation of complexity versus simplicity. We argue that a more productive discussion centres on the multiplicity of complexity orientations, with their diverse disciplinary roots, concepts and terminologies. We discuss this multiplicity and use it to explore how medical education researchers have taken up complexity science in prominent journals in the field. Methods We synthesised the health sciences and medical education literature based on 46 papers published in the last 18 years (2000–2017) to describe the patterns of use of complexity science in medical education and to consider the consequences of those patterns for our ability to advance scholarly conversations about ‘complex’ phenomena in our field. Results We identified four patterns in the use of complexity science in medical education research. Firstly, complexity science is described in a variety of ways. Secondly, multiple approaches to complexity are used in combination in single papers. Thirdly, the type of complexity science used tends to be left implicit. Fourthly, the complexity orientation used is much more commonly located using secondary source citation rather than primary source citation. Conclusions The presence of these four patterns begs the question: Do medical education scholars understand that there are multiple legitimate orientations to complexity science, deriving from distinct disciplinary origins, drawing on different metaphors and serving distinct purposes? If we do not understand this, a cascade of potential consequences awaits. We may assume that complexity science is singular in that there is only one way to do it. This assumption may cause us to perceive our way as the ‘right’ way and to disregard other approaches as illegitimate. However, this perception of illegitimacy may limit our ability to enter into productive dialogue about our complexity science‐inspired research.

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“…The authors have defended their highly popular contribution (Greenhalgh et al 2010), highlighting the subsequent elaboration of their ideas in other publications while arguing the need for greater epistemological development and advocating the use of novel social science methodologies such as the Meta-narrative (Greenhalgh et al 2005) and Realist Review (Best et al 2012) developed by Greenhalgh et al The latter method's application to a local Canadian health system in 2012 also relates this group by coauthorship to the next.…”

Section: Bmj Seriesmentioning

confidence: 99%

Systems thinking in public health: a bibliographic contribution to a meta-narrative review

Chughtai¹,

Blanchet

2017

Health Policy Plan.

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Background Research across the formal, natural and social sciences has greatly expanded our knowledge about complex systems in recent decades, informing a broadly inclusive, crossdisciplinary conceptual framework referred to as Systems Thinking (ST). Its use in public health is rapidly increasing, although there remains a poor understanding of how these ideas have been imported, adapted and elaborated by public health research networks worldwide. Method This review employed a mixed methods approach to narrate the development of ST in public health. Tabulated results from a literature search of the Web of Science Core Collection database were used to perform a bibliometric analysis and literature review. Annual publication counts and citation scores were used to analyse trends and identify popular and potential 'landmark' publications. Citation network and co-authorship network diagrams were analysed to identify groups of articles and researchers in various network roles. Results Our search string related to 763 publications. Filtering excluded 208 publications while citation tracing identified 2 texts. The final 557 publications were analysed, revealing a nearexponential growth in literature over recent years. Half of all articles were published after 2010 with almost a fifth (17.8%) published in 2014. Bibliographic analysis identified five distinct citation and co-authorship groups homophilous by common geography, research focus, inspiration or institutional affiliation. As a loosely related set of sciences, many public health researchers have developed different aspects of ST based on their underlying perspective. Early studies were inspired by Managementrelated literature, while later groups adopted a broadly inclusive understanding which incorporated related Systems sciences and approaches. Conclusion ST is an increasingly popular subject of discussion within public health although its understanding and approaches remain unclear. Briefly tracing the introduction and development of these ideas and author groups in public health literature may provide clarity and opportunities for further learning, research and development.

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Response to ‘The Appropriation of Complexity Theory in Health Care’

Cited by 38 publications

References 22 publications

Leadership practice as interaction in primary care emergency team training

Leadership practice as interaction in primary care emergency team training

What is the state of complexity science in medical education research?

Systems thinking in public health: a bibliographic contribution to a meta-narrative review

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