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Being pragmatic about healthcare complexity: our experiences applying complexity theory and pragmatism to health services research

Overview of attention for article published in BMC Medicine, June 2018
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  • In the top 25% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (87th percentile)
  • Average Attention Score compared to outputs of the same age and source

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Title
Being pragmatic about healthcare complexity: our experiences applying complexity theory and pragmatism to health services research
Published in
BMC Medicine, June 2018
DOI 10.1186/s12916-018-1087-6
Pubmed ID
Authors

Katrina M. Long, Fiona McDermott, Graham N. Meadows

Abstract

The healthcare system has proved a challenging environment for innovation, especially in the area of health services management and research. This is often attributed to the complexity of the healthcare sector, characterized by intersecting biological, social and political systems spread across geographically disparate areas. To help make sense of this complexity, researchers are turning towards new methods and frameworks, including simulation modeling and complexity theory. Herein, we describe our experiences implementing and evaluating a health services innovation in the form of simulation modeling. We explore the strengths and limitations of complexity theory in evaluating health service interventions, using our experiences as examples. We then argue for the potential of pragmatism as an epistemic foundation for the methodological pluralism currently found in complexity research. We discuss the similarities between complexity theory and pragmatism, and close by revisiting our experiences putting pragmatic complexity theory into practice. We found the commonalities between pragmatism and complexity theory to be striking. These included a sensitivity to research context, a focus on applied research, and the valuing of different forms of knowledge. We found that, in practice, a pragmatic complexity theory approach provided more flexibility to respond to the rapidly changing context of health services implementation and evaluation. However, this approach requires a redefinition of implementation success, away from pre-determined outcomes and process fidelity, to one that embraces the continual learning, evolution, and emergence that characterized our project.

X Demographics

X Demographics

The data shown below were collected from the profiles of 20 X users who shared this research output. Click here to find out more about how the information was compiled.
Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 322 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 322 100%

Demographic breakdown

Readers by professional status Count As %
Student > Ph. D. Student 61 19%
Student > Master 52 16%
Researcher 33 10%
Student > Doctoral Student 23 7%
Other 21 7%
Other 56 17%
Unknown 76 24%
Readers by discipline Count As %
Nursing and Health Professions 65 20%
Medicine and Dentistry 60 19%
Social Sciences 29 9%
Business, Management and Accounting 19 6%
Psychology 11 3%
Other 44 14%
Unknown 94 29%
Attention Score in Context

Attention Score in Context

This research output has an Altmetric Attention Score of 18. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 15 November 2020.
All research outputs
#2,007,686
of 25,392,205 outputs
Outputs from BMC Medicine
#1,393
of 3,999 outputs
Outputs of similar age
#40,277
of 335,226 outputs
Outputs of similar age from BMC Medicine
#32
of 59 outputs
Altmetric has tracked 25,392,205 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 92nd percentile: it's in the top 10% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 3,999 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 45.5. This one has gotten more attention than average, scoring higher than 65% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 335,226 tracked outputs that were published within six weeks on either side of this one in any source. This one has done well, scoring higher than 87% of its contemporaries.
We're also able to compare this research output to 59 others from the same source and published within six weeks on either side of this one. This one is in the 47th percentile – i.e., 47% of its contemporaries scored the same or lower than it.