Many wonder why there has been so little change in care quality, despite substantial quality improvement efforts. Questioning why current approaches are not making true changes draws attention to the organization as a source of answers. We bring together the case study method and complexity science to suggest new ways to study health care organizations. The case study provides a method for studying systems. Complexity theory suggests that keys to understanding the system are contained in patterns of relationships and interactions among the system's agents. We propose some of the "objects" of study that are implicated by complexity theory and discuss how studying these using case methods may provide useful maps of the system. We offer complexity theory, partnered with case study method, as a place to begin the daunting task of studying a system as an integrated whole. KeywordsCase study methods; research; complexity science; health care organizations Dr. Jane Russell, Family Physician, spoke at a luncheon with great zeal about the benefits of preventive medicine, transferring her enthusiasm to the audience of family health care providers. It was evident that the individuals in this group felt strongly about the value of prevention as a part of their medical practice. When we examined Dr. Russell's practice for the level of preventive services delivered, therefore, we were greatly surprised to find that, while most women in her practice were up-to-date with mammograms, in only 10% of her patients who smoked tobacco was there any documentation of their ever having been counseled to stop smoking.In order to understand and improve the complex contexts and interactions that lead to anomalies such as those presented by Dr. Russell, theoretical models and research methods are needed for understanding health care organizations. These models and methods need to address questions such as: "Why have we seen so little change in what is being done for clients despite substantial knowledge in the form of best practice guidelines?" "Why is it that a physician, NIH Public Access

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