W(h)ither complexity? the emperor's new toolkit? or elucidating the evolution of health systems knowledge?

Abstract

Rationale The outputs from vastly expanding health research and knowledge industry with a broadening range of approaches to the synthesis of knowledge provide an impetus to develop complex science and theory-informed knowledge management in health care. Aims To stimulate debate in order to assist health care decision makers to move beyond framing certainty and evidence in purely reductionist terms. Objectives To locate health, health care and health knowledge systems research using a complex adaptive systems theory framework. Methods An conceptual analysis of pervading methodologies and ways of knowing in health systems research to elucidate a framework in order to inform health care decision making. Findings A living Tree of (Research) Knowledge is proposed, with theoretic and operational frameworks. Branches of the tree are linked to differing evolutionary and developmental processes in order to assist researchers in the ongoing self-organizing of taxonomies, multiple methods and types of knowledge, recognizing the 'lived', developing and adaptive nature of our understandings. Conclusions It is challenging to determine whither the directions 'knowledge' creation and management should take in complex health systems, beyond a total reliance on reductionism. Yet quality will wither, if knowledge does not pertain to real world contexts. © 2010 Blackwell Publishing Ltd.