Intended for healthcare professionals

Education And Debate Complexity science

The challenge of complexity in health care

BMJ 2001; 323 doi: (Published 15 September 2001) Cite this as: BMJ 2001;323:625

Complex system theory - a breath of fresh air.

Dear Sir

For the last two years, I have been spreading the "gospel" of complex
system theory to healthcare audiences, having heard an inspiring lecture
on the subject followed by one from a representative from NiCE, that so
precisely and painfully illustrated the very reductionist and particulate
mentality now prevalent and that had been so eloquently exposed for its
woeful inadequacy in the previous lecture.

Of course, we have to start somewhere, but in our current
person-management culture, perhaps it is time to understand that complex
system theory contains both the oxygen for thought and vaccination that we
really need if we are going to counter the thought viruses contained in
centrist-control methodologies, globalisation and the "what difference
does my contribution make to the world?" type of thinking,and beyond that
to denial, that is so prevalent amongst many of those I meet at meetings
around the country.

There is a huge, indeed almost crying, need for the messages
contained within even the first of this series, to reach those hapless
folks at the front end of health and social care delivery, since it
contains the crucial message that they too are part of the "shimmering
babbling brook".

Those who wish, or need, to control every aspect of an individual or
system's behaviour also need to hear the message that it is through
networking, creativity, aspiration and individuality that people can rise
above imposed systematisation and the burn-out and disillusion so often
occasioned by the dead reckoning of centrism. We need to help such people
be comfortable with, and even value, tension between different parts of
such systems, without also offering justification to the rest that this is
a golden opportunity for intransigence or stubborness.

Articles will continue to be written about "why don't GPs (inter
alia), follow guidelines on...?" or the difficulty of team-building and
joined-up working, until we can help people emerge into a world where
"both..and" feels as comfortable as "either..or". This, in itself, can
build respect. Further, this message of current understanding needs to be
advanced into the national curriculum and psyche at the earliest
opportunity, before minds do "set". It would also help in terms of
deconstructing the notion that a sense of tension must be corrected or, in
our world, treated. It may be entirely appropriate. As Spinelli recently
stated in the Journal of Psychotherapy - "Some dilemmas do not have
solutions, they can only be lived".

A complex system can also tolerate narrative, anecdote and experience
as evidence equal to any other, whilst validating our own individual
contribution to the world in which we live - a lesson painfully
appropriate from the events of this week, itself demonstrating the truth
of an encapsulation of complex system theory stated in the old aphorism
"chickens do come home to roost".

The cork has to come to the surface. Clinical governance, audit, and
quality assurance all need to allow for the fact that many, if not most
people, do want to deliver more than mediocrity or the minimum - it is
systems of overbearing and mind-numbing mechanistic naivety that so often
crush the human spirit. Blame, targets and odious comparison do not
provide the best or most complete nutrients for most human plantoids.

The messages of this article, aligned as they are to current and best
evidence-based mathematics, need to be heard and understood by health and
social commissioners, providers and users, policy makers and non-evidence-
based political practitioners at the earliest opportunity. I have no doubt
in my own mind that this message is of crucial importance to our age - it
has certainly helped me both to understand and couple up far more
effectively with long-held views and my personal "mission".

Yours Faithfully,

Dr Chris Manning

Conflict of interest - I am an evangelist for the emotional and
spiritual needs of the workforce.

Competing interests: No competing interests

16 September 2001
Chris Manning
Chair Depression Alliance and CEO PriMHE (Primary care Mental Health and Education)