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September 2023 (Volume 101)
Quarterly Article
Trisha Greenhalgh
Eivind Engebretsen
Roland Bal
Sofia Kjellström
December 2025
Mental Health and Substance Use Challenges
September 2025
Back to The Milbank Quarterly
Policy Points:
More than 20 years ago, a series of articles in the British Medical Journal introduced a novel approach to innovation and change, referred to as “complexity thinking” or “complexity theory,” which emphasized the dynamic and unpredictable nature of health care systems.1-4 That series, along with other conceptual papers published at the time,5-7 have been widely cited and informed policies, programs, and research studies around the world. However, these early articles, which depicted complexity in broadly mathematical terms, missed—or, at best, failed sufficiently to emphasize—a key aspect of complexity in health care systems: human values.
In this review paper, we explore the crucial contribution of human values to complex interaction and change. In the form of “simple rules,” we offer some preliminary recommendations for a more contemporary and values-informed approach to complexity in health care. We invite a new generation of research to extend the existing evidence base.
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