Complexity Theory: Developing a Complexity Lens – Part 1.

David Aron, MD, MS  December 28, 2015.

Complexity is popular, made so by novels and films such as Jurassic Park and mass market non-fiction like Chaos: Making a New Science, and Complexity: The Emerging Science at the Edge of Order and Chaos, and many others. The field has been a rich source of metaphors, some more apt than others, and the terminology has been used to put a scientific veneer on evidence light (if not evidence free) opinions and unsophisticated analyses.  Nevertheless, there have been many efforts to advance the field, usually within traditional disciplines, but sometimes in a more transdisciplinary fashion.

The first problem comes with the definition. There are many definitions and descriptions of complex systems.  Melanie Mitchell’s definition has the virtue of brevity and clarity (at least superficially). She defines complex systems as “collections of elements, interacting nonlinearly, which produce emergent behavior.” The only problem with this definition is the use of the words: collections, elements, interacting, nonlinear, produce, and emergent behavior. How these terms are defined and characterized makes a great deal of difference. Nevertheless, although complexity theory/science is still relatively immature, there is still much of value to be learned. It has been argued by David Byrne that the “complexity frame of reference” was a more apt term. This approach was also endorsed by Boulton, Allen, and Bowman. Different scholars and practitioners have parsed complexity in different ways. Several have listed components, while others have divided complexity into broader categories that included several elements. Morin, a philosopher, divided the field into restricted complexity (a scientific and methodological approach) and generalized complexity (a philosophical and epistemological approach).  Manson, a geographer, divided the field into algorithmic, deterministic, and aggregate complexity. Geyer and Rahani, policy scientists divided complex systems into physical, biotic, and conscious.  Another approach would be to divide the field into academic versus experienced complexity (after Beautement and Broenner).

One of the issues is the separation between what might be termed academic complexity and what we experience as complexity.   In much of the academic literature complexity is approached primarily with mathematical models. This is a consequence of the hegemony of “science” and the particular view that rules in the groves of Academe.  These mathematical models are both interesting and informative. For example, the phenomenon of birds flocking or fish schooling can be described in three relatively simple mathematical equations. (see ), demonstrating that simple rules can result in complex behavior. (We err when we go on to conclude that complex behavior always results from simple rules or that we can impose simple rules on a complex system and have completely predictable results.) More recently, qualitative approached have been used, particularly in the context of the increasing popularity of “mixed methods.” A part of the stimulus to the use of qualitative methods is the desire to gain a richer picture of the experience of complexity.  We experience complexity in the world and often depend on intuition and sensemaking. For my course in the Doctorate in Management Program at the Weatherhead School of Management, on managing in complex systems I have felt the need to bridge academic and experiential complexity. Scholarly complexity may constitute that bridge.  I defined scholarly complexity as the conscious and systematic application of principles (regardless of their origin) that underlie complex systems to problems of practice in the real world – praxis. This frame of reference is a different way of looking at things and thus it involves a “complexity lens.”  In Part 2, I will describe the development of a complexity lens.


  • Mitchell M (2009) Complexity: A Guided Tour. Oxford University Press, Oxford UK.
  • Byrne D, Callaghan G. (2014) Complexity Theory and the Social Sciences: The state of the art. Routledge, New York.
  • Boulton JG, Allen PM, Bowman (2015) Embracing Complexity: Strategic Perspectives for an Age of Turbulence. Oxford University Press, Oxford UK.
  • Beautement P. and Broenner C. (2011) Complexity Demystified, Triarchy Press. Axminster, UK.
  • Boisot, M. H., & McKelvey, B. (2010). Integrating modernist and postmodernist perspectives on organizations: A complexity science bridge. Academy of Management Review, 35(3), 415-433.
  • Geyer R., Cairney P. (20016) Handbook on Complexity and Public Policy. Edward Elgar Publishing, Cheltenham, UK.
  • Manson S. (2001) Simplifying complexity: a review of complexity theory. Geoforum 32:405-414.
  • Morin, E. (2007) Restricted Complexity, General Complexity, in: C. Gershenson, D. Aerts & B. Edmonds (eds) Worldviews, Science and Us, Philosophy and Complexity (London, World Scientific) pp. 5–29.
  • Richardson KA. (2008) Managing complex organizations: complexity thinking and the science and art of management. E:CO 10:13-26.

Nothing new under the sun

David C. Aron, MD, MS, OC (optimistic cynic)

Nothing new under the sun.

What has been is what will be,
and what has been done is what will be done,
and there is nothing new under the sun.

Is there a thing of which it is said,
“See, this is new”?
It has been already
in the ages before us.


There is no remembrance of former things,
nor will there be any remembrance
of later things yet to be among those who come after.

Ecclesiastes  1:9-11 (Jewish Publication Society 1917)

The April 2010 issue of AHRQ Research Activities Newsletter led with the astonishing headline: “Patients admitted to the hospital on weekends wait for major procedures.” ( )  This finding was based on a report Characteristics of Weekday and Weekend Hospital Admissions that was based on data from 2007. (


There have been many critiques of health services research. Sometimes it has been called ‘academic,’ meaning not of practical relevance or of only theoretical interest. This particular article brings up another criticism that I have heard (and made) that health services researchers prove the obvious.  The authors of the report have used rigorous methods to support their conclusion and I suppose that should make us feel more comfortable in making the statement with scientific certainty.  However, one has the sense that this is something that could have been predicted more than 2000 years ago.

Genesis 2.1-3.  And the heaven and the earth were finished, and all the host of them. And on the seventh day God finished His work which He had made; and He rested on the seventh day from all His work which He had made. And God blessed the seventh day, and hallowed it; because that in it He rested from all His work which God in creating had made.

Exodus 20:7-10. Remember the sabbath day, to keep it holy. Six days shalt thou labour, and do all thy work; but the seventh day is a sabbath unto the LORD thy God, in it thou shalt not do any manner of work, thou, nor thy son, nor thy daughter, nor thy man-servant, nor thy maid-servant, nor thy cattle, nor thy stranger that is within thy gates; for in six days the LORD made heaven and earth, the sea, and all that in them is, and rested on the seventh day; wherefore the LORD blessed the sabbath day, and hallowed it.

Deuteronomy 5:11-14. Observe the sabbath day, to keep it holy, as the LORD thy God commanded thee. Six days shalt thou labour, and do all thy work; but the seventh day is a sabbath unto the LORD thy God, in it thou shalt not do any manner of work, thou, nor thy son, nor thy daughter, nor thy man-servant, nor thy maid-servant, nor thine ox, nor thine ass, nor any of thy cattle, nor thy stranger that is within thy gates; that thy man-servant and thy maid-servant may rest as well as thou. And thou shalt remember that thou wast a servant in the land of Egypt, and the LORD thy God brought thee out thence by a mighty hand and by an outstretched arm; therefore the LORD thy God commanded thee to keep the sabbath day.

The idea of a day of rest for the working class was an innovation and by no means the usual practice. The Jewish Sabbath was criticized by 1st Century Roman Seneca the Younger who was quoted by Augustine in City of God:  ‘Seneca, among the other superstitions of civil theology, also found fault with the sacred things of the Jews, and especially the Sabbaths, affirming that they act uselessly in keeping those seventh days, whereby they lose through idleness about the seventh part of their life, and also many things which demand immediate attention are damaged.( De Civitate Dei. 6:11) Nevertheless the concept caught on.

Since on the seventh day even God rested and no procedures were performed, is it surprising that delays have been introduced in the system?  I am not suggesting that the fact that the Sabbath appears in the Bible is scientific proof that this is the cause of waiting for procedures.  If anything, it is only correlation rather than proof of causality. Rather, it raises the issue of how much rigorous research is required.  Should we do an RCT to be sure of the causal relationship? Further, if waiting for procedures for patients admitted on weekends was not demonstrated, would you believe it? Is there a plausible counterfactual that would explain those results?  That is also not to say that there is nothing important to be learned here. Which procedures are delayed and whether that makes a difference in outcomes are legitimate research questions that have implications for hospital staffing.  Let us just not let ourselves be carried away with our brilliance. (For the record I am not aiming this at the authors of the study which included many more findings of considerable interest; rather, the idea that this was a headline struck me as funny.) This led me to ask the question, how much of the findings of health services and related management research, particularly in my area of implementation of evidence into practice, were at least foreshadowed in the Hebrew Scriptures.

There are several articles that provide so called lessons learned or prove the importance of one factor or another and these have been published in “high impact journals” (which means that other health services researchers cite them and not that they have high impact on actual practice – I am as guilty as the next in trying to publish in such journals). For example, some of the factors associated with implementation success include:

Leadership –  One need only read the Book of Exodus; and the ever popular importance placed on the leader’s vision.  See Proverbs 29:18

Spatial sufficiency (which probably means enough space)– which facilitates co-location of primary care and mental health clinics  Putting aside the laws of physics which don’t allow two things to occupy the same space simultaneously, one might recall that the Israelites are reminded that God led them out of Egypt. The Hebrew word for Egypt (מִצְרַיִם ) literally means the narrow places. Even then, spatial sufficiency was important.

I have no doubt that there are other examples. Health services researchers would be more useful if they looked at how to implement something in the face of poor leadership or how to accomplish things when space is a constraint. It is time for a change.

Bible translations and numbering from the JPS 1917 Edition