1. Teach EBP?
An introduction to
Complexity theory!

2. Mechanistic / Cause and
effect view of life
• I lead – you follow
• I say – you do
• I manage – you do
• I teach – you learn
• You teach – I pass

3. Complex systems
• Complex systems consist of a large
number of elements
• These interact in a dynamic way
• Each element influences the others and
is influenced in turn
• Most interactions are short range
• But complex systems do interact with
their environment

4. Complex systems contd
• There are loops in the interactions
which can have a +ve or –ve effect
• Complex systems are not in equilibrium
– only survive through a constant flow
of energy
• Present and future behaviour partly
determined by past
• Elements in the system react to local
info and are ignorant of behaviour of
system as a whole

5. (After Stacey, Stephenson & Greenhalgh)
low
a
g
r
e
e
m
e
n
t
high
high low
certainty

6. low
a
g
r
e
e
m
e
n
t
high
high low
certainty

7. environment
low
chaos
a
g
r
e
e
m complexity task
e
n
t
order
high
high low
certainty

8. environment
low
Don’t go here!
a
g
r
e
e
Zone of
m complexity task
e
n Capability
t
Competence
high
high low
certainty

9. Competence
- what individuals know or are able to do in terms of
knowledge, skills and attitude.
Capability
- extent to which individuals can adapt to change,
generate new knowledge and continue to improve
their performance

10. Complexity systems and
education
• The system and its environment is
never constant
• Individuals are independent and
creative decision makers
• Uncertainty and paradox are inherent
within the system
• Problems that can’t be solved can
nevertheless be moved forward

11. Complexity systems and
education contd
• Effective solutions can emerge from
minimum specification
• Small changes can have big effects
• Behaviour exhibits patterns
• Change is more easily adopted when it
taps into these patterns

12. RCA Problem Narrative
cases based
Problem based learner
Change
EBP Management
Audit Ethics
“Process based learning”?

13. Process based learning
Learning driven by needs
Characterised by –
•Dynamic and emergent PLP with explicit goals
•Protected time
•Mentoring and peer support
•Written log or record

14. References
“The challenge of complexity in health care”
Plesk and Greenhalgh - BMJ 2001; 323: 625-8
“Coping with complexity: educating for capability”
Fraser and Greenhalgh - BMJ 2001; 323: 799-803
“Complexity and clinical governance:using the insights to
develop the strategy”
Sweeney and Mannion - BJGP; 52(suppl): S4-S9