Articles | Open Access | https://doi.org/10.55640/

Reconceptualizing Health Care and Organizational Systems through Complexity Science: Theoretical Foundations, Adaptive Dynamics, and Practical Implications

Dr. Elias Moreno , Department of Systems and Health Sciences, Autonomous University of Barcelona, Spain

Abstract

Complexity science has emerged as a powerful interdisciplinary framework for understanding systems characterized by nonlinearity, emergence, adaptation, and uncertainty. Health care organizations, governance structures, and social systems increasingly exhibit these properties, challenging traditional linear, reductionist models of design, management, and evaluation. This article offers an extensive theoretical and conceptual exploration of complexity science as applied to health care and organizational systems, drawing strictly from established foundational and applied literature. By synthesizing perspectives from complex adaptive systems theory, systems thinking, network science, and organizational studies, the paper examines how interactions among heterogeneous agents generate emergent patterns that cannot be fully predicted or controlled. The analysis situates health care as a paradigmatic complex adaptive system, where outcomes arise from dynamic relationships among patients, professionals, technologies, policies, and sociocultural contexts. Methodologically, the article adopts an integrative, theory-driven narrative review approach grounded in systematic literature review principles to ensure conceptual rigor and coherence. The results are presented as a descriptive synthesis of recurring theoretical constructs, empirical insights, and practical implications across health care, primary care, palliative care, integrated care, and governance domains. The discussion critically interrogates the implications of complexity thinking for leadership, quality improvement, accountability, and policy design, while also addressing tensions between complexity-informed approaches and conventional managerial paradigms. Limitations related to operationalization, measurement, and translation into practice are examined in depth, alongside future research directions emphasizing agent-based modeling, reflective practice, and adaptive governance. The article concludes that embracing complexity science does not imply abandoning structure or standards, but rather reframing them as enabling constraints that support learning, resilience, and sustained improvement in complex systems.

Keywords

Complexity science, complex adaptive systems, health care systems

References

Abbott, R.; Hadžikadić, M. Complex adaptive systems, systems thinking, and agent-based modeling. In Advanced Technologies, Systems, and Applications; Springer: Berlin/Heidelberg, Germany, 2017.

Anderson, P. Complexity theory and organization science. Organization Science 1999, 10, 216–232.

Chan, S. Complex adaptive systems. In ESD.83 Research Seminar in Engineering Systems; MIT: Cambridge, MA, USA, 2001.

Cilliers, P. Complexity and Postmodernism: Understanding Complex Systems; Routledge: London, UK, 2002.

Donabedian, A. Quality assessment and assurance: unity of purpose, diversity of means. Inquiry 1988, 25, 173–192.

Ellis, B. Complexity in practice: understanding primary care as a complex adaptive system. Journal of Informatics in Primary Care 2010, 18, 135–140.

Ellis, B. Managing Governance Programmes in Primary Care: Lessons from Case Studies of the Implementation of Clinical Governance in Two Primary Care Trusts; PhD Thesis, University of Central Lancashire, Preston, 2008.

European Foundation for Quality Management. The EFQM Excellence Model. Public and Voluntary Sector Version; EFQM: Brussels, Belgium, 1999.

Gell-Mann, M. The Quark and the Jaguar; Freeman: New York, NY, USA, 1994.

Hodiamont, F.; Jünger, S.; Leidl, R.; Maier, B.O.; Schildmann, E.; Bausewein, C. Understanding complexity—the palliative care situation as a complex adaptive system. BMC Health Services Research 2019, 19, 1–14.

Holland, J.H. Complex adaptive systems. Daedalus 1992, 121, 17–30.

Hughes, G.; Shaw, S.E.; Greenhalgh, T. Rethinking integrated care: a systematic hermeneutic review of the literature on integrated care strategies and concepts. Milbank Quarterly 2020, 98, 446–492.

Jagustović, R.; Zougmoré, R.B.; Kessler, A.; Ritsema, C.J.; Keesstra, S.; Reynolds, M. Contribution of systems thinking and complex adaptive system attributes to sustainable food production. Agricultural Systems 2019, 171, 65–75.

Kauffman, S.A. Origins of Order: Self-Organization and Selection in Evolution; Oxford University Press: Oxford, UK, 1993.

Kernick, D. The demise of linearity in managing health services; a call for post-normal healthcare. Journal of Health Services Research and Policy 2002, 7, 121–124.

Kernick, D. Complexity and Healthcare Organisation; Radcliffe Publishing: Oxford, UK, 2002.

Kernick, D. Complexity and Healthcare Organisation: A View from the Street; Radcliffe Publishing: Oxford, UK, 2004.

Kitchenham, B.; Charters, S. Guidelines for Performing Systematic Literature Reviews in Software Engineering; EBSE Technical Report; Keele University and Durham University, 2007.

Ladyman, J.; Lambert, J.; Wiesner, K. What is a complex system? European Journal for Philosophy of Science 2013, 3, 33–67.

Martin-Martin, A.; Thelwall, M.; Orduna-Malea, E.; Delgado López-Cózar, E. Google Scholar, Microsoft Academic, Scopus, Dimensions, Web of Science, and OpenCitations’ COCI. Scientometrics 2021, 126, 871–906.

Meek, J.W.; De Lauduranty, J.; Hewell, W.H. Complex systems, governance and policy administration consequences. Emergence: Complexity and Organization 2007, 9, 24–36.

Mitchell, M. Complex systems: Network thinking. Artificial Intelligence 2006, 170, 1194–1212.

Papert, S. Introduction. In The Embodiments of Mind; MIT Press: Cambridge, MA, USA, 1965.

Plsek, P.E.; Greenhalgh, T. The challenge of complexity in health care. BMJ 2001, 323, 625–628.

Reynolds, C.W. Flocks, herds and schools: a distributed behaviour model. Computer Graphics 1987, 21, 25–34.

Roper, W.; Cutler, C. Health plan accountability and reporting: issues and challenges. Health Affairs 1998, 17, 152–155.

Rouse, W.B. Health care as a complex adaptive system: implications for design and management. The Bridge 2008, 38, 17.

Simon, H.A. The architecture of complexity. In Facets of Systems Science; Springer: Berlin/Heidelberg, Germany, 1991.

Stroebel, C.K.; McDaniel, R.R. Jr.; Crabtree, B.F.; et al. How complexity science can inform a reflective process for improvement in primary care practices. Joint Commission Journal on Quality and Patient Safety 2005, 31, 438–446.

Zimmerman, B.; Lindberg, C.; Plsek, P. A Complexity Science Primer: What Is Complexity Science and Why Should I Learn About It? In Edgeware: Lessons from Complexity Science for Health Care Leaders; VHA Inc.: Dallas, TX, USA, 1998.

Article Statistics

Downloads

Download data is not yet available.

Copyright License

Download Citations

How to Cite

Reconceptualizing Health Care and Organizational Systems through Complexity Science: Theoretical Foundations, Adaptive Dynamics, and Practical Implications. (2026). International Journal of Business and Management Sciences, 6(01), 1-6. https://doi.org/10.55640/