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Understanding Complexity in Health Systems: International Perspectives

Guest Editors: Prof Trish Greenhalgh and Dr Chrysanthi Papoutsi

New Content ItemIn this collection, BMC Medicine presents a series of papers that extend the theoretical and empirical knowledge base on the topic of complexity science and its application to health care systems.

Health systems around the world are struggling with the unprecedented interacting challenges of – among others – increased life expectancy (and the concomitant increase in chronic illness, multi-morbidity and frailty), technological progress (both real and imagined), the convergence of ‘health’ and ‘care’ needs (along with increasingly messy disputes over who should pay for them), fragmentation of services, mismatches between workforce supply and system demand, a mushrooming of regulations and protocols, diminishing public trust in health professionals, and shrinking budgets.

Complexity science will not provide a simple fix for the inherent tensions and paradoxes in contemporary health systems. But a better understanding of complexity science will help us develop appropriate responses.

In addition to the papers already included in this collection, we are seeking submissions that meet the following criteria:

  • Offering an original and important perspective on the application of complexity science to contemporary challenges in healthcare,
  • Based on a robust and richly-described empirical study (qualitative, quantitative or both) and/or including rigorous theoretical analysis,
  • Offering an innovative study design, methodology and analytic approach to the study of complexity that could be applied more widely,
  • Accessible to a generalist BMC Medicine audience, particularly professionals not specialising in complexity science.

Fields that might be covered include (but are not limited to):

  • The naturalistic study of complex change (e.g. organizational case studies and what has been termed ‘muddling through’ in policymaking);
  • Studies that illustrate and explain modelling and microsimulation techniques in accessible and practical ways;
  • Approaches to handling the mismatch between model/ideal and reality;
  • The application of complexity principles to shift the debate on ‘behaviour change’;
  • Discussion of key implications and suitable approaches for the implementation of complexity science in clinical practice, hospital administration, global health, or policy.

 We welcome direct submissions of original research within the collection's scope until June 2019 – please submit directly to BMC Medicine, stating in your cover letter that you are targeting this collection. Alternatively, please email your pre-submission queries to

  1. Content type: Research article

    Ensuring effective identification and management of sepsis is a healthcare priority in many countries. Recommendations for sepsis management in primary care have been produced, but in complex healthcare system...

    Authors: Duncan McNab, John Freestone, Chris Black, Andrew Carson-Stevens and Paul Bowie

    Citation: BMC Medicine 2018 16:174

    Published on:

    A Letter has been published.

  2. Content type: Research article

    The science of complex systems has been proposed as a way of understanding health services and the demand for them, but there is little quantitative evidence to support this. We analysed patterns of healthcare...

    Authors: Christopher Burton, Alison Elliott, Amanda Cochran and Tom Love

    Citation: BMC Medicine 2018 16:138

    Published on:

  3. Content type: Opinion

    The healthcare system has proved a challenging environment for innovation, especially in the area of health services management and research. This is often attributed to the complexity of the healthcare sector...

    Authors: Katrina M. Long, Fiona McDermott and Graham N. Meadows

    Citation: BMC Medicine 2018 16:94

    Published on:

  4. Content type: Research article

    Failures and partial successes are common in technology-supported innovation programmes in health and social care. Complexity theory can help explain why. Phenomena may be simple (straightforward, predictable,...

    Authors: Trisha Greenhalgh, Joe Wherton, Chrysanthi Papoutsi, Jenni Lynch, Gemma Hughes, Christine A’Court, Sue Hinder, Rob Procter and Sara Shaw

    Citation: BMC Medicine 2018 16:66

    Published on:

  5. Content type: Opinion

    Implementation science has a core aim – to get evidence into practice. Early in the evidence-based medicine movement, this task was construed in linear terms, wherein the knowledge pipeline moved from evidence...

    Authors: Jeffrey Braithwaite, Kate Churruca, Janet C. Long, Louise A. Ellis and Jessica Herkes

    Citation: BMC Medicine 2018 16:63

    Published on: