Book: 'Complexity in Health Care - A Paradigm Shift for Clinical Practice'

This book was published in 2023, so I am most grateful to Daniela and colleagues at SpringerNature for the review copy. My reading will also inform both the presentation I've to deliver, and the learning during the conference's three days and the rest of a visit to Morocco.

With a 15 minute talk and 5 minutes for questions, I have 15 slides. The final one, is a listing of sources, plus this book:

1. Estrada, E., Submitted (2026) Emergent Geometry in Complex Systems from Relational Dynamics. I. The Classical Setting.
https://ifisc.uib-csic.es/en/publications/emergent-geometry-in-complex-systems-from-relation/
2. Napoli, P.H., Fischer, B., Salati Marcondes de Moraes, G.H. et al. (2026). When complexity does not mean chaos: nonlinear dynamics of entrepreneurial ecosystems. J Technol Transf  https://doi.org/10.1007/s10961-025-10314-7
3. Hylin MJ, Kerr AL, Holden R. Understanding the Mechanisms of Recovery and/or Compensation following Injury. Neural Plast. 2017;2017:7125057. doi: 10.1155/2017/7125057. Epub 2017 Apr 20. PMID: 28512585; PMCID: PMC5415868.
4. Zanin, M., Papo, D. (2020) Assessing functional propagation patterns in COVID-19. Chaos, Solitons & Fractals 138, 109993
5. 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
6. Bergström, J., & Dekker, S. W. A. (2014). Bridging the Macro and the Micro by Considering the Meso: Reflections on the Fractal Nature of Resilience. Ecology and Society, 19(4), art22. https://doi.org/10.5751/ES-06956-190422
7. Rickles, D., Hawe, P., & Shiell, A. (2007). A simple guide to chaos and complexity. Journal of Epidemiology & Community Health, 61(11), Article 11. https://doi.org/10.1136/jech.2006.054254
8. Miller, K. (2007). From Fears of Entropy to Comfort in Chaos: Arcadia, The Waste Land, Numb3rs, and Man’s Relationship With Science. Bulletin of Science, Technology & Society, 27(1), 81-94.
9. Frankel, Steven & Thurber, Steven & Bourgeois, James. (2023). Complexity in Health Care: A Paradigm Shift for Clinical Practice. Cham: Springer. 10.1007/978-3-031-14949-8.

Also pointing to the bibliography in the sidebar and the template link. 

More to follow ...

WCCS26: Abstract 'Presenting a Universal and Simple Conceptual Workbench to Situate and Encompass Complexity'

ABSTRACT

Background

In health and social care there is, as yet, no universally recognised model, or framework applied and taught across all academia, fields of practice, professional disciplines and apprenticeships. At a time when ‘truth’ is challenged by information disorder, AI, and curricula are overload, this is both a stark and hidden problem. Medicine was quick to embrace complexity as an additional scientific tool. Complexity extends our understanding of epidemiology, demographic trends, the birth of modern bio-genomics, pharmacokinetics, public health, workflows, patient safety and more. The medical and bio-medical models are subject to critique, especially in psychiatry in terms of their conceptual scope and holistic bandwidth. Consider for example, the representation of patient and public engagement, human rights, climate change, poverty, refugees and natural disasters? The field of psychiatry extended these models to the bio-psycho-social model.

Methods

Despite this ‘progress-ion’, profound legacy issues remain: 

• The dualities of INDIVIDUAL-GROUP and HUMANISTIC-MECHANISTIC
• Sustainable services and systems, change to emphasize prevention and education (not just cure)
• A lack of parity of esteem between mental illness and physical illness
• A complicated relationship between psychiatry and psychology

The 21st century demands we also factor in economics, technology, social media - especially AI, education and literacies, geopolitics, security and more. This paper argues that we need a bio-psycho-socio-political model stat! This paper introduces and demonstrate the generic conceptual framework known as Hodges’ model.

To date, Hodges’ model has been explained and studied by guided discovery through lectures, workshops, posters, show and tell, and discussion groups; plus descriptive means of case study, and in practice patient care assessments and case formulation. Journal papers include conceptual analysis and synthesis, concept mapping of issues, e.g. nutrition and the sustainable development goals, plus oral health and policy frameworks (in-process). This paper ‘workbench’ encourages and facilitates reflective practice and critical thinking on an individual and collective basis. The derivation of the structure and content of Hodges’ model through guided discovery will be shared.

Results & Discussion

The background to Hodges’ model and its creation is introduced. In health care delivery, evidence-based interventions are of course paramount to patient, and public safety. Work to ‘see’ Hodges’ model as a mathematical object has begun. Help and collaboration is welcome; especially with supervisors of early career researchers and scholars in LMICs. Examples of complexity will be mapped to the knowledge (care) domains of Hodges’ model, which can itself be embedded within the spiritual. This paper responds directly to WCCS26’s main theme; and the need to listen to the lessons of history and isolate, weigh, refine and seek to preserve the often hard-won values that sustain humanity, humanistic care and qualities at a time when these are under assault, e.g. assisted dying – a right to die, or a duty? A small but growing bibliography, a template, plus illustrations of Hodges’ model are provided. Background on Hodges’ model can be found in the blog ‘Welcome to the QUAD’ - https://hodges-model.blogspot.com

Keywords: Healthcare, Nursing, Hodges’ model, Humanities, Global health

Topic: Complexity in Health and Medicine

🔷

News of acceptance was received on 29th November: brilliant! The deadline for submission of full-papers is 25th December. Try as I might, I can't meet this date. 

Helpfully, a presentation based on abstract alone is acceptable. I am hoping to network and learn too. The draft notes on Hodges'model as a mathematical object (6k words) are helpful in framing thoughts about the presentation and a future paper as a writing project. All in, a marvellous end to 2025 and prospect for 2026.

The dynamics of life and death

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

dynamic care?	dynamic care?
dynamic care?	'dynamic pricing'

Cavet emptor!

Beware -

 you get what you pay for; but do you get what you pay for?

Previously on W2tQ - 'dynamic'

Life, Literacy, Oppositions, Complexity and Information

Literacy in Traditional Societies

"Durkheim's work on primitive classification is being applied to societies within the orbit of major civilizations. The polarities and oppositions of la pensée sauvage turn up in ancient Greece, and tools developed in the study of the narratives of American societies are applied to the Oedipus story, the Book of Genesis and even contemporary literature, with little sense of the basic incongruity involved.

Polarities of some sort are of course present in all societies; their significance, however, varies widely. Aristotle describes one Pythagorean theory in the following terms:

 

Others of this same school say that there are ten principles, which they arrange in ten columns, namely:

limit unlimited
odd even
one plurality
right left
male female
at rest moving
straight crooked
light darkness
good bad
square oblong

. . . How these principles maybe brought into line with the causes we have mentioned is not clearly explained to them [quoted Guthrie 1962: 1, 245]."

Goody, J. (1968) Literacy in Traditional Societies, Cambridge: CUP. pp.10-11.


Taking each of these in-turn as may relate to Hodges' model (I may update/edit these):

limit  unlimited

As a template the model invites both a limit (boundaries) and some-thing unlimited.

odd  even

There is a symmetry - evenness to the model, but the invitation noted above is also a prospect for odd-ness. This may extend to the frustration experienced when a phenomena, account (patient's narrative . . .) defies explanation and classification.

one  plurality

This polarity is key in Hodges' model. 'One' refers to the person, patient, carer, any - individual who the model is applied to. In respect of plurality this can include the dyad of patient - nurse, couple, family, team, community, national or global population (and Biosphere).

 

right  left
 

The horizontal axis is not the last word in Hodges' model, as intra-domain we also find right and left. Of course, the vertical axis (indeed, the whole model if required?) can also be repeated in a domain.

 

male  female

 

You quickly recognise the potential for disagreement* which is fundamental in dichotomous situations, a point further reinforced below.

at rest  moving

 

The model is 'at rest' as a snap-shot, but as a frame it can represent the change over time and so has its own dynamic potential.

 

straight  crooked

 

The axes as continua are 'straight' but this distinction (as noted above) has distinct psycho-socio-political connotations. In the model, line-of-sight is acknowledged, while 'crooked' might suggest what is uncertain, and unseen?

 

light  darkness & good  bad

 

Again, these two oppositions seem 'loaded': especially socially - politically.

Tread carefully. If you have light, that's good, but if lost: bad.

 

square  oblong

 

Viewed as containers, or sets the model's domains can be represented as several shapes, as long as the axes are retained as part of the structure. The adopted rectilinear form is an affordance of the (underlying) HTML, and the traditional (paper-based) tabular format. From the domains being of equal area, the point where the axes intersect could be shifted, such that a single domain is enlarged (prioritised?), at the expense of another.

*Incredible harmony too!

Then prior to an anticipated move, and sorting through books and papers:

Complexity:
Life on the edge of chaos

“The discovery that universal computation is poised between order and chaos in dynamical systems was important in itself, with its analogies to phase transitions in the physical world. It would be interesting enough if adaptive complex systems inescapably were located at the edge of chaos, the place of maximum capacity for information computation. The world could then be seen to be exploiting the creative dynamics of complex systems, but with no choice in the matter. But what if such systems actually got themselves to the edge of chaos, moved in parameter space to the place of maximum information processing?” p.54.

Lewin, R. (1993) Complexity: Life on the edge of chaos. London: Phoenix.

The conclusion? 

Perhaps, the ubiquity of polarity, opposition and dichotomy is that they anticipate and presage an increase in information processing (for good or ill: there we go again!). 

This is also a ( the ) function of Hodges' model.

Previously:

Opposition  . . . See also - Polarity , Dichotomy , Literacy . . .