The practice of complexity: review, change and service improvement in an NHS department

In the last five years more and more scholars have drawn on insights from the complexity sciences as a way of understanding the process of managing and organising in the NHS differently. This paper aims to describe working methods derived from the theory of complex responsive processes, a more radical interpretation of these insights, used by a consultancy team in one NHS setting.

The authors were invited to undertake this intervention over a two year period to bring about service improvement. The paper sets out a critique of systems theory, which underpins most management literature, as well as offering a critique of some of the ways that complexity theory gets taken up in the health literature. As an alternative it explores the theoretical underpinnings of complex responsive processes and gives practical examples of methods that the authors believe are more suitable for understanding the complex environment NHS staff work within.

Working with ideas of ambiguity, paradox and complexity are not easy for staff educated in a Western tradition of linear cause and effect. However, as a result of this intervention managers and staff pointed to a much greater confidence and skill in dealing with the complex daily process of organising, which they attribute to the methods used. Although the authors make no claim that service improvement arose as a direct consequence of the methods employed, significant, observable improvements in service provision did occur during and after the consultancy intervention.

The description of working methods based on reflective and reflexive group processes, alongside more empirical data-gathering methods, is offered as a radical alternative to more orthodox ways of understanding, and attempting to work with change in the NHS.