Making Sense of System Boundaries: Critical Realism and Healthcare Policy Design

Abstract

Healthcare systems and organizations are increasingly recognized as complex adaptive systems (CAS) formed of agents whose interactions within a context produce outcomes. However, if complexity science helps us describe what happens within a system, we are still left with questions as to why they happen. Malone proposes critical realism as a theoretical framework to explain causality in systems. This framework allows to identify and explain generative mechanisms which determine outcomes and shape systems. Malone illustrates the benefits of the approach through an illustrative case study that seeks to explain the dynamics of healthcare policy design in France. Critical realism allows Malone to hypothesize a “Boundary control” mechanism that is instrumental in explaining the dynamics of the French policy advisory system.