Table 2.

Examples of threshold concepts from CHEPSAA’s courses

Threshold concepts shared across the courses
• Health policies and systems are socially constructed; they exist within contexts and histories and are driven by and impact on a range of agents • Health systems comprise interacting dimensions of ‘hardware’ and ‘software’ • People are at the centre of the health system, driven by values and contexts • The health system is knowable and changeable
Selected threshold concepts unique to the courses
Introduction to Complex Health Systems	Introduction to Health Policy and Systems Research
Health systems are integrative by nature, and consist of complex inter-relationships; we all have a role in the system	HPSR + A is intentionally multidisciplinary and embraces multiple perspectives
Health system effectiveness is a ‘whole system’ judgement rather than one based on the effectiveness of specific interventions	Health care services/interventions/programmes provide a lens through which to investigate policy and systems issues (i.e. they are not the primary focus of the research)
People make sense of the system around them and act based on their understandings and mind sets	Good (i.e. sound) research design requires that the study design fits the question, issues and purpose
Power is everywhere: in agency, service delivery and decision-making	There is no hierarchy of study design in terms of quality and rigour in HPSR + A; and quality and rigour are always important
Everyone has a part to play in the system, working towards shared goals	Researcher curiosity, attentiveness and reflexivity are the basis of rigorous HPSR + A
The health system is a complex adaptive system	Theoretical ideas and concepts have value (as a guide for study design and analysis in HPSR + A)