ABSTRACT
Most people in healthcare readily embrace the idea that they work in a complex system. The concept of healthcare as a complex system seems to be widely recognized (Pisek & Greenhalgh, 2001). But do we know what we mean when we say complex? How is complex different from complicated, for example? And for that matter, do practitioners and managers in healthcare typically act in ways that are appropriate for complex systems? There is a strong tendency to reach for simple solutions, for silver bullets, for single-factor explanations. And it is still common to bemoan the “ineptitude” of those defeated by the complexity of the system (Gawande, 2002) or to celebrate the “strength of character” of those able to bring it under control (Pellegrino, 2004). There is a lingering focus, in other words, on good and bad components rather than on the system. Of course, this may be inextricably connected to issues of identity and competence in healthcare, as discussed in Chapter 1. But focusing on components is something that can work in simple, or merely complicated, systems. It is useless in complex systems.
