David Kernick
Complexity and Healthcare Organisation: A View from the Street
Radcliffe Publishing
2004 PB, 392 pages, £29.95, 1 85775 814 5
The second of three in a series of books on complexity theory from Radcliffe Publishing, this substantial work describes how complexity theory may be applied to healthcare organisation.
The editor, David Kernick, needs no introduction to regular readers of this Journal. A GP based in a research practice in Exeter, he has played a major role in the leadership of the Complexity in Primary Care Group, established in 2000. His connections have garnered a wide authorship for this book, whose 28 chapters and many illustrations give undoubted value for money. The foreword by Helen Bevan of the NHS Modernisation Agency reflects the support her organisation has given to complexity research in recent years. Contributors include practitioners and academics from (primary and secondary) health and social care, management consultants, policy makers, philosophers and artists.
As well as the authorship, the book's scope and content are broad. I particularly enjoyed the coverage of systems theory, organisational learning, educating for capability, and the critical care programme. The chapter on community regeneration provides a clear example of complexity principles improving the lives of individuals and communities. The artists' contributions work well, and a further chapter, written more or less as an unplanned conversation, similarly transfers the principles of responsive communication and adaptation to the layout (and not just the message) of the book.
Arising from mathematics and the physical sciences, complexity theory has readily (and usefully) been transferred to management and social sciences, but it is often claimed that there is then little resemblance to the concepts and terms as originally defined. As an example, the term ‘attractor’ tends to be used a little too liberally for my own taste, and this book is no exception, although I note that some of its authors share my view. This is an issue for any author or teacher of the subject. Many feel that to adhere too strictly to purist terminology excludes access for the majority to an important development of the 20th century. This view is justifiable in the areas covered by this book, which is generally about complex phenomena in large organisations, where the sociological insights are more important than hard mathematical theory. It is less justifiable in the study of clinical and physiological systems, where the models can be tested by more quantitative means, and mathematical rigor is then more of a help than an obstacle. This spectrum from ‘hard’ to ‘soft’ approaches is well covered in chapter 4 of this book, and both provide opportunities for the application of complexity principles, depending on the context and the availability of numerical data. The editor begins with a well pitched introduction to the theory, and finishes with a glossary in which unfamiliar terms are defined. There are a few mathematical footnotes, but no-one should be put off this work because of mathematical naivety.
So who should buy this book? There is something here for any healthcare manager, commissioner, practitioner or allied health professional. It will also interest teachers of health care, as a resource for students of medicine, nursing, healthcare management studies, health policy and health economics. But one word of warning: don't expect to finish it in an evening. This work is lengthy, for all the right reasons, not because the authors have become entrenched in opaque or inaccessible theory, but because it is stuffed full of examples of applications in everyday situations. David Kernick makes this intention clear in his well chosen subtitle: this is a view from the street, accessible to anyone, particularly those, to use his own favourite metaphor, working knee-deep in the swampy lowlands of primary care.
- © British Journal of General Practice, 2005.