Toward a Values-Informed Approach to Complexity in Health Care: Hermeneutic Review

Health Care Practice / Quality

Policy Points:

  • The concept of value complexity (complexity arising from differences in people’s worldviews, interests, and values, leading to mistrust, misunderstanding, and conflict among stakeholders) is introduced and explained.
  • Relevant literature from multiple disciplines is reviewed.
  • Key theoretical themes, including power, conflict, language and framing, meaning-making, and collective deliberation, are identified.
  • Simple rules derived from these theoretical themes are proposed.

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.

Open Access



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  2. Plsek PE, Wilson T, Greenhalgh T. Complexity, leadership and management in healthcare organisations. BMJ.2001;323(7315):746-749.
  3. Wilson T, Holt T, Greenhalgh T. Complexity science: complexity and clinical care. BMJ. 2001;323(7314):685-688.
  4. Fraser SW, Greenhalgh T. Coping with complexity: educating for capability. BMJ. 2001;323(7316):799-803.
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Greenhalgh T, Engebretsen E, Bal R, Kjellström S. Toward a Values-Informed Approach to Complexity in Health Care: Hermeneutic Review.Milbank Q. 2023;101(3):0523.