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Analysis Quality Improvement

Changing how we think about healthcare improvement

BMJ 2018; 361 doi: (Published 17 May 2018) Cite this as: BMJ 2018;361:k2014

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Re: Changing how we think about healthcare improvement

Jeffrey Braithwaite opened a very valuable discussion about complexity in healthcare and how it should influence our thinking about healthcare improvement.

One important organizational aspect of healthcare lies within information and communication technology (ICT) that also is characterized by high complexity. Therefore, I like to refer to an article entitled:
Cultivating complex ICT in health care: the gardeners perspective (by W. Fierz) with the following abstract:

It is a widely hold view that management of information in health care with the help of information and communication technology (ICT) should follow a certain strategy in order to cope with the complexity of health care. However, when looking for a theoretical background for a strategy that is apt to complexity one has to go beyond the field of ICT and consider new conceptual frameworks that have already started to influence science, society and organizational life. It follows from such novel veins of thinking that complex organizations in a changing environment can not be strictly planned anymore but need a more flexible and caring approach that rather needs the skills of a gardener than those of an engineer. Here, it is advocated that a strategy for ICT in health care should also follow such avenues.

The full article is available at:

Competing interests: No competing interests

18 May 2018
Walter Fierz
Clinical laboratory
lmz Dr Risch
Labormedizinisches Zentrum Dr Risch, 9490 Vaduz, Liechtenstein