Reviewed by
Brian Castellani
Kent State University
In 2013 Joachim Sturmberg sent me a wonderful email asking if I would like to participate with his team in putting together an international conference devoted to the utility of the complexity sciences for improving health and healthcare around the world. Sturmberg’s argument to me, which can also be found on the website for the conference, was convincing:“The 21st century explanatory models in health, health care and health professions education are no longer fit for purpose. Simple interventions like antibiotic therapies and vaccination have made significant contributions to reduce the premature mortality rates due to infectious disease. However, healthcare in the 21st century is confronted with the global systems-based challenges from chronic disease to lifestyle illnesses and global disease transmissions. The etiology of these health problems is complex and simple interventions no longer suffice in dealing with them. Systems and Complexity Sciences offer a different model to understand and manage these emerging challenges”.
How could I say no. And so I joined the team, and over the course of the following year we put together Systems and Complexity Sciences for Healthcare: A Conference on the Imperative for Systems Science in the 21st Century, which was co-hosted in 2014 by Georgetown University Medical Center and by the MedStar Institute for Innovation, both located in the greater Washington D.C. area.
Of particular import for our group was the conference’s subtitle and, in particular, our usage of the term ‘imperative’ – which denotes something crucial or of vital importance; that is, an essential or urgent thing. For us (or so our reasoning went) the success of medicine in the 21st century is not simply augmented by an embrace of complexity; instead, it is entirely dependent upon it.
The same argument and reasoning can be said of the fifty-one authors who contributed to the edited monograph that came from the conference – of which I was not a participant, just to be clear. The Value of Systems and Complexity Sciences for Healthcare is a brilliant book, and is, in my estimate, as equally valuable for the success of 21st century medicine as the complexity sciences it supports.
Several reasons:
First, the book is organized into two useful, pragmatically focused sections: complexity in clinical care and complexity in managing healthcare systems.
Second, the chapters in each section are concise in their reasoning and focus. I was able, for example, to read through two or three chapters at a time, and in roughly about fifteen to twenty minute segments. In this way the book functions as a useful reference, to which one can return to for insights and ideas.
Third, the topics covered within each section vary considerably. For example, the section on clinical care ranges from such topics as the importance of complexity for diagnosis and patient safety to the clinical value of systems biology and systems-based epidemiology to managing variability and complexity at the bedside to dealing with mental health from a systems perspective. In turn, the section on managing healthcare systems ranges from a team-based approach to the complexities of quality improvement to the ethical complexities of healthcare management to a systems-based approach to the challenges of accessing primary care.
Fourth, the chapters vary in method, including discussions of agent-based modeling and innovations in systematic literature reviews to network analysis and statistical modeling.
Fifth, the authors are truly international in scope – and this was on purpose on the part of Sturmberg and colleagues – including such countries as Canada, Australia, the UK, Austria, South Africa, Germany, Belgium, the States and Ireland. One of the major problems in the sciences today, including the complexity sciences, is a tendency toward network-like academic cliques in which the flow of ideas is significantly restricted, even in the case of interdisciplinary research. One of the unintended consequences of such ‘cliquish science’ is the stifling of a truly international, open-the-sciences style thinking and exchange of ideas. Such is not the case with the current book. In fact, I found the opposite to be the case, as the chapters seems applicable to a wide variety of health topics and healthcare settings and systems – which leads to my next point.
Sixth, the chapters do not seek to provide the definitive solution to an issue. Instead, given their concise nature, they seek to outline or suggest the value that complex systems thinking has (or might have) for a particular topic. As such, when reading these chapters one becomes much less interested in whether an author is entirely correct and much more interested in taking the author’s journey – almost as if the author(s) is/are having a conversation with you, trying to see what you think as much as what they think – which is impressive.
Finally, all twenty-one chapters are on reasonably equal footing intellectually; the result being an edited series that functions at a very high level of scholarly quality and integrity.
In short, this is an important book and it needs to be read by practitioners and researchers in the fields of health and healthcare alike. As Steven Hawking famously stated, science in the 21st century is about complexity. In the face of such complexity, such an edited book as this one by Sturmberg and colleagues is not just of value, it is imperative.
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