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Reducing and Responding to Complexity

Greenhalgh and colleagues have adapted existing [133] principles for managing complexity, so that they are relevant to the development of a Learning Health [134] System. They suggest that teams:

Acknowledge unpredictability: Designers of interventions should contemplate multiple plausible futures. Implementation teams should tailor designs to the local context and view surprises as opportunities.

Recognise self-organisation: Designers should expect their designs to be modified, perhaps extensively, as they are taken up in different settings; implementation teams should actively capture data and feed it into the adaptation process.

Facilitate interdependencies: Designers should develop methods to assess the nature and strength of interdependencies; implementation teams should attend to these relationships, reinforcing existing ones where appropriate and facilitating new ones.

Encourage sensemaking: Designers should build focused experimentation into their designs; implementation teams should encourage participants to ask questions, admit ignorance, explore paradoxes, exchange different viewpoints, and reflect collectively.

Develop adaptive capability in staff: Individuals should be trained not merely to complete tasks as directed but to tinker with technologies and processes and make judgments when faced with incomplete or ambiguous data.

Attend to human relationships: People must work together to embed innovation, solving emergent problems using give-and-take and “muddling through”. Harness conflict productively: There is rarely a single, correct way to tackle a complex problem, so look upon conflicting perspectives as the raw ingredients for multifaceted solutions.