Principle 5. Embracing complexity
Embracing complexity and using systems thinking helps to understand the rich tapestry of stakeholders; consider network effects; and adopt flexible and responsive planning cycles versus rigid, linear timelines.
- Organisations can be very complex, and many aspects of the health service environment will influence the willingness and enthusiasm of managers or providers in the health, disability, social, educational and community-based sectors to be engaged and involved. Factors include:
- Leadership structure and lines of reporting (risk perception; sense of agency)
- Workforce profile (availability; sense of relevance relative to other priorities)
- Inter-professional, intra-service, and inter-service relationships
- Impacts and pressures from previous unsuccessful advocacy or implementation of local innovations, and past or current policy-driven (top-down) change processes.
- Proposed actions to improve identified issues will vary in complexity. Implementing a mixture of quick wins (less complex but low impact) and more complex, time-consuming actions that have higher impact is important in maintaining momentum over the project timeline.
- Using systems thinking can help view communities as networks of tightly connected actors or stakeholders and recognise how changing the actions/decisions of one member will have ripple effects through the rest of the network.
- Complexity also reminds us that social networks are stable and often resistant to change; a commitment to relationship building at different levels and in different spaces, with different stakeholders is essential to supporting creative thinking and helping stakeholders step outside their comfort zone(s) to engage with possibilities, despite perceptions of barriers or past failures.
- Successful processes must be flexible to account for factors that influence engagement or participation at different times of the process.
Complexity in place-based health planning was experienced in various ways. Engagement was required with managers at multiple levels in the preparatory stages and was ongoing. Frontline managers were not always able to, or were uncomfortable with, contributing without more senior-level permission. As the work was part of a research project, evidence of community support was required, as well as ethics approval and governance authorisation. We found that understanding various programs and services supporting the health of the community, their funding models, scope and eligibility criteria was confusing. Arrangements for funding and serviceability also changed regularly, adding to the confusion.
Previous experiences with researchers and community politics impacted upon willingness to be involved in the project. In Kowanyama, previous research had branded researchers with a reputation for collecting data with no feedback provided, changes made or any perceived benefit for the community. Impacts and pressures from previous unsuccessful advocacy or implementation of local innovations, and past or current policy-driven (top-down) change processes were disincentives to participate in Clermont.
Relationships between organisations and social networks—whether among individuals or groups—can have both positive and negative effects. Active engagement, consistent presence in the community, and strong relationship-building contributed to enhancing the external teams’ reputation in planning efforts. By aligning values, identifying common goals, and ensuring everyone had a voice in decision-making, the process fostered unity and strengthened the quality of the discussions.
