by Muir Gray
Journal of the Royal Society of Medicine; 2017, Vol. 110(5) 183–187
When health services get into difficulty, a common response is to change their structure, method of financing or both. However, these together comprise only one aspect of a service. A service consists of people and an organisation, and the organisation, in turn, has three different elements. The right structure is useful for simple tasks, but most health and healthcare issues are complex, where complexity is defined as ‘the dynamic state between order and chaos’. This means there is no linear relationship between input and output, but that their relationship is unpredictable; the carefully planned input may not lead to the desired output, and unintended consequences abound.