Wanted--new methodologies for health service research. Is complexity theory the answer?

Abstract

Despite a recognition that health service research has failed to make its full contribution to health service improvement, the fact that evidence is not widely accommodated into practice is seen as a failure of communication rather than the inappropriate application of a particular form of investigation. Dominant theoretical frameworks still retain the fundamental idea that order needs to be somehow created by external forces and that organizational issues will inevitably yield to more collection of data and the application of increasingly sophisticated analytical techniques. This paper explores alternative perspectives and methodological opportunities that arise from viewing health service as a complex non-linear system. This approach may offer new research insights that more accurately reflect underlying mechanisms and may help to explain the limitations of current analytical techniques.

Systems and Complexity Thinking in the General Practice Literature: An Integrative, Historical Narrative Review

“…24 Likewise, exploration of the biopsychosocial model of care and the consultation showed that they are better understood as emergent, dependent on the individuals involved and the conditions at the time of presentation. Given this fact, models of care need to account for circular causalities, whereby feedback loops, either self-balancing (stabilizing) or self-rein- [23][24][25][26][27][28][29] Applying complexity science principles to the function of medical practice 23 and the understanding of the biopsychosocial model 28 Family practices are local professional complex adaptive systems 24 Understanding and managing in complex adaptive systems 26 Constructing a complexity model of continuity of care and illustrating its veracity using previously published outcomes data 27 Understanding the interconnected issues affecting the primary care workforce crisis 29 The function of medical practice Healing is the process of reestablishing wholeness 30,45,47,49 Consultation dynamics 31,45,46 and outcomes 32,46 Care team development, practice development, and dynamics 35,57,58 Health systems and health system reform [36][37][38]43,44,50,[52][53][54] Toward an integrated understanding of health 37,47,49 and disease 41,…”

“…Last, the education sector itself has come to recognize that adult education is best guided by concepts of continued self-organized learning. 36 Complex adaptive systems approaches are consequently more likely to achieve lasting quality improvement 55 and avoidance of "surprising unintended consequences." [49][50][51][52][53] Core to generalist practice are the view of the whole patient, the ability to deal with the uncertainties of people's illnesses, and the changing context-dependent dynamics of illness over time.…”

Going for gold: A prospective assessment of the economic impacts of the Commonwealth Games 2014 on the East End of Glasgow

“…To do this we developed a 3-P framework for the assessment in three parts: people and place of the East End; programmes of intervention; and plausibility of economic impact. By taking a look at the prospects for economic impact, and looking towards the post-Games period, we hope our work can eventually help with issues of attribution of effects (Weiss 1997), transferability of conclusions to other Games sites (Kernick and Mannion 2005) , and policy-relevance of findings from evaluations of multi-sport events (Stame 2004;Kernick 2006).…”

“…As argued by Marchal et al (2012), a theory-based approach, in our case allied to a prospective assessment, can help with three of the difficulties faced by conventional evaluations, namely by improving attribution claims (Weiss 1997), enhancing the transferability of findings to other settings (Kernick and Mannion 2005), and making the findings more relevant for policy-makers by highlighting how they are sensitive to context (Stame 2004;Kernick 2006). …”

A theoretical framework for multimorbidity: from complicated to chaotic

“…Other, more practical approaches to research in complex health systems have been proposed. 34,35 In the example of Table 1, the practitioner explores the patient's family relationships and the reason for his heavy drinking. The practitioner reflects upon his own experiences of alcohol abuse and draws upon metaphor that resonates with the patient's experience to describe his predicament, interjecting with appropriate irony and humour.…”