Complexity science as a frame; or, a frame for complexity science?

In reading for WCCS later this month, I wonder if Braithwaite et al. (open access) may have found Hodges' model useful in addressing both the learning objectives and questions they raise in their chapter; and as a response to the recommendations?

Braithwaite J, Ellis LA, Churruca K, et al. Complexity Science as a Frame for Understanding the Management and Delivery of High Quality and Safer Care. 2020 Dec 15. In: Donaldson L, Ricciardi W, Sheridan S, et al., editors. Textbook of Patient Safety and Clinical Risk Management [Internet]. Cham (CH): Springer; 2021. Chapter 27. Available from: https://www.ncbi.nlm.nih.gov/books/NBK585611/ doi: 10.1007/978-3-030-59403-9_27

' Learning Objectives and Questions Covered in the Chapter

• How does a linear view of improvement contrast with a complexity science approach? 
• The complexity frame makes it harder to manage and deliver high quality and safer care — does it therefore need to be rejected in favour of simpler improvement models?
• What examples can be brought to bear to show how studies in the complexity frame can lead to good outcomes and positive change?'

'In addition, in homing in on any part of a CAS, we can discern elements of both selfsimilarity and local nuances. Self-similarity can manifest fractally, at different scales (e.g., features of the culture of the organisation at the team level approximate to that of the culture of the department, and then division, and then the whole organisation) or laterally (e.g., one department looks comparable structurally to another). It might seem paradoxical, but healthcare levels or departments, despite being self-similar in some respects, also each operate as unique entities. There are always localised contextual, cultural and structural distinctions. Such local nuances occur as the result of the particular configurations of agents (e.g., nurses, doctors, quality managers, patients) following their internalised rules and shared mental models (e.g., put the patients first, project a good reputation to the outside world, prioritise safety) in that unique setting.' pp.378-379.

'Bringing clinicians from different departments together with the patient as the focus, provided a deeper understanding of other’s roles and barriers, helped create a shared mental model, and fostered a whole-of-system approach to the care for patients with this condition.' p.382.

[CAS - Complex Adaptive System]
 

'Recommendations

1. Sensitise those with responsibility for leading, managing, improving or researching care settings to a systems view. 
2. Train sufficient staff in the tools of complexity: FRAM, network analyses, system dynamics modelling, process mapping, and the like. 
3. Approach quality and safety and risk management activities with a knowledge of complexity science, sense-making, and non-linearity rather than as a set of linear problems amenable to simplistic causal change logic. 
4. Consider how our studies, borrowing from complexity theory, have resisted simplifying the challenges, but have nevertheless made progress in understanding care systems and their improvement.' p.389.

 [FRAM - Functional Resonance Analysis Method]

 I will include this in my presentation, duly cited:

 'Complexity science as a frame: or, frame for complexity science?'

Vectors of the Biopolitical - (Chap. 2) c/o Bull

The Concept of the Social

'From one sentence in Aristotle derive two arresting theoret- ical discourses of the twenty-first century: Michel Foucault's biopolitics, provocatively reformulated by Giorgio Agamben in terms of the relationship between sovereignty and the body, and the capabilities approach developed by Amartya Sen and Martha Nussbaum as a means of evaluating and promoting development, justice and freedom. Both are characterized by deep reflection on the sources of Western political thought, and by urgent engagement with contemporary social and legal problems. Both are in some sense biopolitical in that they are shaped by the interplay of the same Aristotelian categories the human and the animal, politics and nature. But they are on opposite sides of the divide that has opened up in the human sciences since the 1960s, and there currently seems no optic through which they might simultaneously be viewed, no way of integrating or comparing their insights.

 

In part, this reflects a situation in which political debate appears to have fragmented into a multiplicity of single issues. The ancient 'Who will rule?' and the modern 'Who shall have what?' have been supplemented by an array of questions that deal with matters once exclusively cultural, personal or natural. For previous eras, the relative integrity and unmalleability of cultures, bodies and environments rendered such questions redundant. Now they frequently appear unanswerable from within established political traditions, and incommensurable in relation to each other. Within this expanded field, biopolitics and the capabilities approach have unusual salience and potential, for both bundle together issues otherwise assumed to be distinct. If they, in turn, could be coordinated, perhaps we could begin to map the new territory.' p.68.

individual

|

INTERPERSONAL : SCIENCES

humanistic ------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group

'Who shall have what?'	nature human - animal bio-
culture	political 'Who will rule?'

Bull, M. (2021) The Concept of the Social, London: Verso.