Complexity science

Editor—Plsek and Greenhalgh's example of complexity in health care is absurd.¹ Do they really encourage us to believe that, if only Dr Simon had some grounding in complexity theory, she would have been able to understand why getting rid of lunch time upsets her colleagues? We do not have to appeal to the science of complex adaptive systems, chaos theory, catastrophe theory, Einstein's general theory of relativity, quantum mechanics, or even Freudian psychoanalysis to appreciate the distress of Dr Simon's hungry staff.

Although Plsek and Greenhalgh's aim may have been to make some fairly abstract science more accessible, the result is misleading and potentially harmful. The series does not articulate honestly the background to the emerging study of complex adaptive systems by switching repeatedly between misapplied metaphor and empirically grounded science. I suppose contemporary NHS managerialism has to have its own body of knowledge and set of techniques to bolster a sense of expertise, but it could do better than borrow from the wilder shores of the popular business section of the airport bookstore.

Greenhalgh's series continues the tradition of misusing scientific concepts by confusing technical terms (for example, non-linear, attractor pattern) with “homey” everyday ideas (for example, hidden needs and motivations), in the manner described by Sokal and Bricmont.² This misuse of mathematical metaphor is hardly an original treatment and was regularly promulgated among business management organisations in the United States for at least a decade. Late and a bit stale, it is beginning to appear regularly in the BMJ.³ The antirationalist outcome has more in common with 19th century romanticism than the sophisticated, postmodern thinking that proponents imagine they practise—serving political and careerist, rather than scientific, ends. There are useful applications of chaos theory (an established subset of the more speculative complexity theory) in the clinical sciences: the analysis of cardiac electrical rhythms; electroencephalography in epilepsy; sugar concentrations in diabetes patients; the behaviour of waiting lists; and so on. Unfortunately these ideas may be swamped by the intellectual snake oil of “complexity theory as metaphor,” easily identified by the absence of mathematical modelling, which I fear we can expect to see spattered, expensively, across massed ranks of flip charts by healthcare administration faddists in the United Kingdom.

Plsek and Greenhalgh seem to authorise a means by which uncomfortable situations (for example, tension caused by poorly managed services) may be dismissed as spooky natural phenomena over which to stroke one's chin—a handy conceptual toolkit for the credulous healthcare manager on an inadequate budget.