Bridging the ‘Two Cultures’ of Research and Service: Can Complexity Theory Help?; Comment on “Experience of Health Leadership in Partnering With University-Based Researchers in Canada – A Call to ‘Re-imagine’ Research”

Document Type : Commentary


University of Oxford, Oxford, UK


This commentary addresses Bowen et al’s empirical study of perspectives of Canadian healthcare staff towards research and their call for multi-faceted action to improve misalignments in the system. This commentary argues that tensions and misalignments between research and service are inherent and can never be eradicated. Building on previous work by Lanham et al, I propose seven principles of complexity which may help to develop system capacities that will help bridge the research-service gap: acknowledge unpredictability, recognise selforganisation, facilitate interdependencies, encourage sensemaking, attend to human relationships, develop adaptive capabilities in staff, and harness conflict productively.


Main Subjects

  1. Bowen S, Botting I, Graham ID, et al. Experience of health leadership in partnering with university-based researchers in Canada – a call to “re-imagine” research. Int J Health Policy Manag. 2019; In Press. doi:10.15171/ijhpm.2019.66
  2. Greenhalgh T, Papoutsi C. Studying complexity in health services research: desperately seeking an overdue paradigm shift. BMC Med. 2018;16(1):95. doi:10.1186/s12916-018-1089-4
  3. Cohn S, Clinch M, Bunn C, Stronge P. Entangled complexity: why complex interventions are just not complicated enough. J Health Serv Res Policy. 2013;18(1):40-43.
  4. Braithwaite J, Churruca K, Ellis LA, et al. Complexity Science in Healthcare-Aspirations, Approaches, Applications and Accomplishments: A White Paper. Australia: Macquarie University; 2017.
  5. Greenhalgh T. How to Implement Evidence-Based Healthcare. Oxford: John Wiley & Sons; 2017.
  6. Plsek PE, Greenhalgh T. Complexity science - The challenge of complexity in health care. BMJ. 2001;323(7313):625-628. doi:10.1136/bmj.323.7313.625
  7. Shiell A, Hawe P, Gold L. Complex interventions or complex systems? Implications for health economic evaluation. BMJ. 2008;336(7656):1281-1283.  doi:10.1136/bmj.39569.510521.AD
  8. Hawe P, Shiell A, Riley T. Theorising Interventions as Events in Systems. Am  J  Community Psychol. 2009;43(3-4):267-276. doi:10.1007/s10464-009-9229-9
  9. Greenhalgh T, Papoutsi C. Spreading and scaling up innovation and improvement. BMJ. 2019;365:l2068. doi:10.1136/bmj.l2068
Volume 9, Issue 2
February 2020
Pages 87-88
  • Receive Date: 28 September 2019
  • Revise Date: 09 October 2019
  • Accept Date: 12 October 2019
  • First Publish Date: 01 February 2020