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Professor Trish Greenhalgh and Dr Chrysanthi Papoutsi have edited a new article collection proposing a complexity-informed paradigm in researching health services and systems.

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A new special issue on ‘Understanding Complexity in Health Systems: International Perspectives’ has been launched by BMC Medicine, guest-edited by Professor Trish Greenhalgh and Dr Chrysanthi Papoutsi from the Nuffield Department of Primary Care Health Sciences and Green Templeton College at the University of Oxford.

This new series aims to:

  1. explain what complexity thinking is and how it challenges some of the deeply-held assumptions held by the medical community about how the world works;
  2. illustrate how complexity-informed research and scholarship can provide insights and ways forward for some of medicine’s most intractable problems;
  3. outline a future research agenda for the study of complexity in medicine and healthcare.

The accompanying editorial to the series argues that medicine’s interest in complexity has been largely superficial, both theoretically and empirically. Although it is fashionable to talk of complex interventions and wicked problems, with few exceptions, health research has embraced the theme of complexity in name only and failed to engage with its underlying logic.

Many researchers are still using methods that assume a closed system in which predictive studies in general, and controlled experiments in particular, are possible and preferred. Instead, the editors argue that in open systems characterised by dynamically changing inter-relationships and tensions, conventional research designs predicated on linearity and predictability must be augmented by the study of how we can best deal with uncertainty, unpredictability and emergent causality.

The series calls for new standards of quality in the study of complexity in health services and systems, such as rich theorising, generative learning and pragmatic adaptation to changing context. This framing of complexity-informed health services research provides a useful backdrop for the five empirical studies presented in the launch of the series. The empirical articles cover diverse topics, such as mental health, respiratory conditions, medicines management, hospital-based rapid response teams, system-level accreditation mechanisms and digital health solutions. Each of these papers illustrates, in different ways, the value of theoretically grounded, methodologically pluralistic, flexible and adaptive study designs.

The editors invite readers to engage in complexity-informed healthcare research by continuing to contribute to this thematic collection. Submissions are open until June 30, 2019.

The open call for this special collection was prompted by the international workshop “We Need to Talk about Complexity” sponsored and hosted by Oxford’s Green Templeton College in June 2017. Organised by Trish Greenhalgh and colleagues, the workshop was attended by 60 participants from eight countries. Sessions covered a range of theoretical perspectives and empirical studies from different disciplines, with participants making thought-provoking contributions.

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