Skip to main content

Main menu

  • HOME
  • ONLINE FIRST
  • CURRENT ISSUE
  • ALL ISSUES
  • AUTHORS & REVIEWERS
  • SUBSCRIBE
  • RESOURCES
    • About BJGP
    • Conference
    • Advertising
    • BJGP Life
    • eLetters
    • Librarian information
    • Alerts
    • Resilience
    • Video
    • Audio
    • COVID-19 Clinical Solutions
  • RCGP
    • BJGP for RCGP members
    • BJGP Open
    • RCGP eLearning
    • InnovAIT Journal
    • Jobs and careers
    • RCGP e-Portfolio

User menu

  • Subscriptions
  • Alerts
  • Log in

Search

  • Advanced search
British Journal of General Practice
  • RCGP
    • BJGP for RCGP members
    • BJGP Open
    • RCGP eLearning
    • InnovAIT Journal
    • Jobs and careers
    • RCGP e-Portfolio
  • Subscriptions
  • Alerts
  • Log in
  • Follow bjgp on Twitter
  • Visit bjgp on Facebook
  • Blog
  • Listen to BJGP podcast
Advertisement
British Journal of General Practice

Advanced Search

  • HOME
  • ONLINE FIRST
  • CURRENT ISSUE
  • ALL ISSUES
  • AUTHORS & REVIEWERS
  • SUBSCRIBE
  • RESOURCES
    • About BJGP
    • Conference
    • Advertising
    • BJGP Life
    • eLetters
    • Librarian information
    • Alerts
    • Resilience
    • Video
    • Audio
    • COVID-19 Clinical Solutions
The Back Pages

Commentary 1

Cary A Brown
British Journal of General Practice 2004; 54 (502): 404.
Cary A Brown
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Info
  • eLetters
  • PDF
Loading

THE author has skilfully put forward an argument expressing the frustration of many healthcare providers feeling somewhat attacked by the growing focus on concepts of postmodernism, complexity science and qualitative analysis in the literature. One cannot take issue with his conclusion that constructing simplistic, decontextualised arguments will misrepresent positivist and reductionist medical science. Equally, the same holds true for the theoretical perspectives the author himself is critiquing. The constraints of word length have perhaps contributed to Hopayian running the risk of committing the same mistake with the theoretical underpinnings of emerging views of health and illness. In regards to complexity science in healthcare, Sweeney clearly states that:

‘It's not about debunking science, or relegating the contribution of science in medicine to the intellectual shredder.’1

Rather, complexity science is about recognising that health and illness require a range of approaches, responsive to the unpredictable and idiosyncratic aspects of both the individual and society. A dispassionate review of the literature clearly demonstrates that complexity science does not seek to refute the phenomenal achievements brought about through applying reductionist scientific methods in medical research. What is contested is the linear dichotomy of reductionist thinking prevalent in biomedical thinking. ‘If it were simple, word would have gotten round’ (Derrida in 2). Because health is not simple, more flexibility and less infighting is imperative.

Hopayian's essay serves a vital role in flagging up the unrest (perceived or overt) inherent in any challenge to the conventional way of thinking. Complexity theory offers a route for reconciling and legitimising the diverse range of theoretical perspectives currently applied to healthcare and helps clinicians avoid the counterproductive sparring inherent in either/or linear thinking. The myriad of interacting and idiosyncratic elements that make up health and illness require a range of explanatory models depending on the circumstances and context. The focus is on ‘this’, as well as ‘that’, and understanding the relationships that move systems in certain directions. Management strategies for influencing outcomes in complex systems focus on flexible simple rules as opposed to highly structured and micro-engineered solutions. The concepts of ‘good enough vision’, balancing between control and flexibility, safety and risk, valuing diversity and free flow of information, accepting paradox and dissent as opportunities for innovating new ideas, implementing small actions as opposed to one big solution and accepting the power of, and working with, informal organisational systems are all tools for effecting change in complex adaptive systems.1,3-8 Developing simple rules that can be creatively addressed in ways that accommodate local context and circumstances is a philosophy clearly articulated by the NHS Modernisation Agency's statement of five simple rules9:

  1. See things through the patient's eyes.

  2. Find a better way of doing things.

  3. Look at the whole picture.

  4. Give frontline staff the time and the tools to tackle the problem.

  5. Take small steps as well as big leaps.

The director of the NHS Modernisation Agency, David Fillingham, stated that: ‘the NHS is the epitome of a complex adaptive system. Such systems do not always respond well to mechanistic formulae’.10 Complexity science, and linearity and reductionism and positivism and the hypotheticodeductive model of science are all here to stay — it's just a matter of learning to use the right tool at the right time.

  • © British Journal of General Practice, 2004.

Commentary 1 references

  1. ↵
    1. Sweeney K,
    2. Griffiths F
    (2002) Complexity and healthcare: an introduction (Radcliffe Medical Press, Oxford).
  2. ↵
    1. Cilliers P
    (1998) Complexity and postmodernism (Routledge, London), p 56.
  3. ↵
    1. Fraser SW,
    2. Greenhalgh T
    (2001) Coping with complexity: educating for capability. BMJ 323(7316):799–803.
    1. Lefebvre E,
    2. Letiche H
    (1999) Managing complexity from chaos: uncertainty, knowledge and skills. Emergence 1(3):7–15.
    1. Burns JP
    (2001) Complexity science and leadership in healthcare. J Nurs Adm 31(10):474–482.
    1. Anderson RA,
    2. McDaniel RR
    (2000) Managing health care organizations: where professionalism meets complexity science. Health Care Manage Rev 25(1):83–92.
    1. Zimmerman B,
    2. Lindberg C,
    3. Plsek P
    (2001) Edgeware: insights from complexity science for health care leaders (VHS Press, Irving, Texas).
  4. ↵
    1. Kernick D
    (2002) The demise of linearity in managing health services: a call for post normal health care. J Health Serv Res Policy 7(2):121–124.
  5. ↵
    1. Department of Health
    (2003) Achieving real improvement for the benefit of patients: NHS Modernisation Agency Annual Review 2002/2003 (Department of Health, London).
  6. ↵
    1. Fillingham D
    (2002) Open space. Take five. Health Serv J 112(5791):27.
View Abstract
Back to top
Previous ArticleNext Article

In this issue

British Journal of General Practice: 54 (502)
British Journal of General Practice
Vol. 54, Issue 502
May 2004
  • Table of Contents
  • Index by author
Download PDF
Article Alerts
Or,
sign in or create an account with your email address
Email Article

Thank you for recommending British Journal of General Practice.

NOTE: We only request your email address so that the person to whom you are recommending the page knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Commentary 1
(Your Name) has forwarded a page to you from British Journal of General Practice
(Your Name) thought you would like to see this page from British Journal of General Practice.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Commentary 1
Cary A Brown
British Journal of General Practice 2004; 54 (502): 404.

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero

Share
Commentary 1
Cary A Brown
British Journal of General Practice 2004; 54 (502): 404.
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
  • Mendeley logo Mendeley

Jump to section

  • Top
  • Article
    • Commentary 1 references
  • Info
  • eLetters
  • PDF

More in this TOC Section

The Back Pages

  • Working with vulnerable families in deprived areas
  • What is the collective noun for a group of patients?
  • Development of undergraduate family medicine teaching in China
Show more The Back Pages

essay 3

  • Commentary 2
Show more essay 3

Related Articles

Cited By...

Advertisement

BJGP Life

BJGP Open

 

@BJGPjournal's Likes on Twitter

 
 

British Journal of General Practice

NAVIGATE

  • Home
  • Current Issue
  • All Issues
  • Online First
  • Authors & reviewers

RCGP

  • BJGP for RCGP members
  • BJGP Open
  • RCGP eLearning
  • InnovAiT Journal
  • Jobs and careers
  • RCGP e-Portfolio

MY ACCOUNT

  • RCGP members' login
  • Subscriber login
  • Activate subscription
  • Terms and conditions

NEWS AND UPDATES

  • About BJGP
  • Alerts
  • RSS feeds
  • Facebook
  • Twitter

AUTHORS & REVIEWERS

  • Submit an article
  • Writing for BJGP: research
  • Writing for BJGP: other sections
  • BJGP editorial process & policies
  • BJGP ethical guidelines
  • Peer review for BJGP

CUSTOMER SERVICES

  • Advertising
  • Contact subscription agent
  • Copyright
  • Librarian information

CONTRIBUTE

  • BJGP Life
  • eLetters
  • Feedback

CONTACT US

BJGP Journal Office
RCGP
30 Euston Square
London NW1 2FB
Tel: +44 (0)20 3188 7679
Email: journal@rcgp.org.uk

British Journal of General Practice is an editorially-independent publication of the Royal College of General Practitioners
© 2021 British Journal of General Practice

Print ISSN: 0960-1643
Online ISSN: 1478-5242