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

Tags:
Perspective
Topics:
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

Read the full TEXT ON WILEY ONLINE LIBRARY

References

  1. Plsek PE, Greenhalgh T. Complexity science: the challenge of complexity in health care. BMJ. 2001;323(7313):625-628.
  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.
  5. Anderson RA, McDaniel Jr. RR. Managing health care organizations: where professionalism meets complexity science. HealthCare Manage Rev. 2000;25(1):83-92.
  6. Miller WL, Crabtree BF, McDaniel R, Stange KC. Understanding change in primary care practice using complexity theory. JFam Pract. 1998;46(5):369-376.
  7. Taylor JS. A complexity science primer: what is complexity science and why should I learn about it. Adapted from: Edgeware: Lessons From Complexity Science for Health Care Leaders. Comput Sci. 2015.

Citation:
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.