The Paradox of Intervening in Complex Adaptive Systems; Comment on “Using Complexity and Network Concepts to Inform Healthcare Knowledge Translation”

Document Type : Commentary

Author

Cochrane, London, UK

Abstract

This commentary addresses two points raised by Kitson and colleagues’ article. First, increasing interest in applying the Complexity Theory lens in healthcare needs further systematic work to create some commonality between concepts used. Second, our need to adopt a better understanding of how these systems organise so we can change the systems overall behaviour, creates a paradox. We seek to manipulate systems that self-organise and follow their own internal rules. Although, our actions may impact and indeed meet some of our objectives, system behaviour will always emerge with unpredictable consequences. Likewise, outcomes at the aggregated level of the system never reaches an optimal point as defined by the ‘external controller.’ Kitson and colleagues’ theoretical model may struggle to resolve the paradox of gaining control over the multiple knowledge translation (KT) systems covered by the model, because theoretically these systems retain control under the principle of self-organisation. That is not to suggest that individual agents cannot influence system dynamics just that the desired outcome cannot be guaranteed. Indeed, for systems to change they will need strong incentives.

Keywords

Main Subjects

References

  1. May CR, Johnson M, Finch T. Implementation, context and complexity. Implement Sci. 2016;11(1):141. doi:10.1186/s13012-016-0506-3
  2. Westhorp G. Using complexity-consistent theory for evaluating complex systems. Evaluation. 2012;18(4):405-420. doi:10.1177/1356389012460963
  3. Griffiths F, Borkan J, Byrne D, et al. Developing evidence for how to tailor medical interventions for the individual patient. Qual Health Res. 2010;20(12):1629-1641. doi:10.1177/1049732310377453
  4. Mowles C. Complex, but not quite complex enough: The turn to the complexity sciences in evaluation scholarship. Evaluation. 2014;20(2):160-175. doi:10.1177/1356389014527885
  5. Chandler J, Rycroft-Malone J, Hawkes C, Noyes J. Application of simplified Complexity Theory concepts for healthcare social systems to explain the implementation of evidence into practice. J Adv Nurs. 2016;72(2):461-480. doi:10.1111/jan.12815
  6. Kitson A, Brook A, Harvey G, et al. Using Complexity and Network Concepts to Inform Healthcare Knowledge Translation. Int J Health Policy Manag. 2018; Forthcoming. doi:10.15171/ijhpm.2017.79
  7. Rutter H, Savona N, Glonti K, et al. The need for a complex systems model of evidence for public health. Lancet. 2017;390(10112):2602-2604. doi:10.1016/s0140-6736(17)31267-9
  8. 8.     Boaz A, Baeza J, Fraser A. Effective implementation of research into practice: an overview of systematic reviews of the health literature. BMC Res Notes. 2011;4:212. doi:10.1186/1756-0500-4-212
  9. Pound P, Campbell R. Exploring the feasibility of theory synthesis: A worked example in the field of health related risk-taking. Soc Sci Med. 2015;124:57-65. doi:10.1016/j.socscimed.2014.11.029
  10. Thompson DS, Fazio X, Kustra E, Patrick L, Stanley D. Scoping review of complexity theory in health services research. BMC Health Serv Res. 2016;16:87. doi:10.1186/s12913-016-1343-4
  11. Westhorp G. Using complexity-consistent theory for evaluating complex systems. Evaluation. 2012;18(4):405-420. doi:10.1177/1356389012460963
  12. Cilliers P. Complexity and Postmodernism: Understanding complex systems. London: Routledge, Taylor & Francis Group; 1998.
  13. Byrne D. Complexity Theory and the Social Sciences. Abingdon, Oxons, UK: Routledge; 1998.
  14. Byrne D. Applying Social Science: The Role of Social Research in Politics, Policy and Practice. Bristol, UK: The Policy Press; 2011:20.
  15. Sawyer RK. Social Emergence: Societies as Complex Systems. New York, USA: Cambridge University Press; 2005.
  16. Holland JH. Complex Adaptive Systems. Daedalus.1992;121(1):17-30.
  17. Stacey RD. Strategic Management and Organizational Dynamics: The Challenge of Complexity. 4th ed. Essex, UK: Prentice Hall, Financial Times, Pearson Education Ltd; 2003.
  18. Strumberg JP, Martin C. Handbook of systems and Complexity in Health. New York, US: Springer Science & Business Media; 2016.

Files

History

  • Receive Date: 20 October 2017
  • Revise Date: 13 January 2018
  • Accept Date: 13 January 2018
  • First Publish Date: 01 June 2018

Share

How to cite

Statistics