Without Systems and Complexity Thinking There Is no Progress - or Why Bureaucracy Needs to Become Curious; Comment on “What Can Policy-Makers Get out of Systems Thinking? Policy Partners’ Experiences of a Systems-Focused Research Collaboration in Preventive Health”

Document Type : Commentary


1 School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia

2 International Society for Systems and Complexity Sciences for Health, Waitsfield, VT, USA


The bureaucracy’s goal is to maintain uniformity and control within discrete areas of activity and relies on hierarchical processes and procedural correctness as means to suppress autonomous decision making. That worldview, however, is unsuited for problem solving of real world VUCA (Volatility, uncertainty, complexity and ambiguity) problems. Solving wicked problems in the VUCA world requires curiosity, creativity and collaboration, and a willingness to deeply engage and an ability to painstakingly work through their seemingly contradictory and chaotic pathways. In addition, it necessitates leadership. Leaders require a deep – indeed academic – understanding of the nature of the problems and the veracity of various problem-solving approaches. Leadership after all means “[facilitating] the necessary adaptive work that needs to be done by the people connected to the problem.” That are the people at the coalface who understand and have to manage the complexities relating to problems unique to their local environment for which of the shelf solutions never work. Systems and complexity thinking is more than a tool, it is – in a sense – a way of being, namely deeply interested in understanding the highly interconnected and interdependent nature of the issues affecting our life and work. Hence, system and complexity thinking is, contrary to what Haynes and colleagues state in their “summation for the public reader,” neither “overwhelming and hard [nor difficult] to use practically.” Such a view is as much misleading as self-defeating.


  1. Sturmberg JP. Approaching complexity-start with awareness. J Eval Clin Pract. 2020. doi:10.1111/jep.13355
  2. Haynes A, Garvey K, Davidson S, Milat A. What can policy-makers get out of systems thinking? Policy partners' experiences of a systems-focused research collaboration in preventive health. Int J Health Policy Manag. 2020;9(2):65-76. doi:10.15171/ijhpm.2019.86
  3. Sturmberg JP. If you change the way you look at things, things you look at change. Max Planck’s challenge for health, health care, and the healthcare system. In: Sturmberg JP, ed. Embracing Complexity in Health: The Transformation of Science, Practice, and Policy. Cham: Springer International Publishing; 2019:3-44. doi:10.1007/978-3-030-10940-0_1
  4. Sturmberg JP, Martin CM. Complexity and health--yesterday's traditions, tomorrow's future. J Eval Clin Pract. 2009;15(3):543-548. doi:10.1111/j.1365-2753.2009.01163.x
  5. Ackoff RL. Systems thinking and thinking systems. Syst Dyn Rev. 1994;10(2‐3):175-188. doi:10.1002/sdr.4260100206
  6. Sturmberg JP. Health System Redesign: How to Make Health Care Person-Centered, Equitable, and Sustainable. Cham: Springer International Publishing; 2018.
  7. Brown T, Martin RL. Design for action. Harv Bus Rev. 2015;93(9):56-13.
  8. Marshall DA, Burgos-Liz L, IJzerman MJ, et al. Applying dynamic simulation modeling methods in health care delivery research-the SIMULATE checklist: report of the ISPOR simulation modeling emerging good practices task force. Value Health. 2015;18(1):5-16. doi:10.1016/j.jval.2014.12.001
  9. Rittel HWJ, Webber MM. Dilemmas in a general theory of planning. Policy Sci. 1973;4(2):155-169. doi:10.1007/BF01405730
  10. Caron D. It's a VUCA world. http://www.slideshare.net/dcaron/its-a-vuca-world-cips-cio-march-5-2009-draft.  Accessed January 23, 2020. Published 2009.
  11. Lawrence K. Developing Leaders in a VUCA Environment. https://www.emergingrnleader.com/wp-content/uploads/2013/02/developing-leaders-in-a-vuca-environment.pdf.  Published 2013.
  12. Mencken HL. The Divine Afflatus. Prejudices: Second Series. New York: Alfred A. Knopf; 1920.
  13. Sterman JD. Learning from evidence in a complex world. Am J Public Health. 2006;96(3):505-514. doi:10.2105/ajph.2005.066043
  14. Heifetz RA. Leadership Without Easy Answers. Cambridge, MA: Harvard University Press; 1994.
  15. Grisold T, Peschl MF. Why a systems thinking perspective on cognition matters for innovation and knowledge creation. A framework towards leaving behind our projections from the past for creating new futures. Syst Res Behav Sci. 2017;34(3):335-353. doi:10.1002/sres.2456
  16. Harper PR. A framework for operational modelling of hospital resources. Health Care Manag Sci. 2002;5(3):165-173. doi:10.1023/a:1019767900627
  17. Brailsford SC, Harper PR, Patel B, Pitt M. An analysis of the academic literature on simulation and modelling in health care. J Simul. 2009;3(3):130-140. doi:10.1057/jos.2009.10
  18. Atkinson JA, Wells R, Page A, Dominello A, Haines M, Wilson A. Applications of system dynamics modelling to support health policy. Public Health Res Pract. 2015;25(3):e2531531. doi:10.17061/phrp2531531
  19. Esensoy AV, Carter MW. Health system modelling for policy development and evaluation: Using qualitative methods to capture the whole-system perspective. Oper Res Health Care. 2015;4:15-26. doi:10.1016/j.orhc.2014.12.002
  20. Friel S, Pescud M, Malbon E, et al. Using systems science to understand the determinants of inequities in healthy eating. PLoS One. 2017;12(11):e0188872. doi:10.1371/journal.pone.0188872
  21. Martin CM, Sturmberg JP. Perturbing ongoing conversations about systems and complexity in health services and systems. J Eval Clin Pract. 2009;15(3):549-552. doi:10.1111/j.1365-2753.2009.01164.x
  22. Murray E, Treweek S, Pope C, et al. Normalisation process theory: a framework for developing, evaluating and implementing complex interventions. BMC Med. 2010;8:63. doi:10.1186/1741-7015-8-63
  • Receive Date: 02 February 2020
  • Revise Date: 17 March 2020
  • Accept Date: 24 March 2020
  • First Publish Date: 01 May 2021