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研究卫生服务研究中的复杂性:迫切需要一场姗姗来迟的范式转变。

Studying complexity in health services research: desperately seeking an overdue paradigm shift.

机构信息

Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.

Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.

出版信息

BMC Med. 2018 Jun 20;16(1):95. doi: 10.1186/s12916-018-1089-4.

Abstract

Complexity is much talked about but sub-optimally studied in health services research. Although the significance of the complex system as an analytic lens is increasingly recognised, many researchers are still using methods that assume a closed system in which predictive studies in general, and controlled experiments in particular, are possible and preferred. We argue that in open systems characterised by dynamically changing inter-relationships and tensions, conventional research designs predicated on linearity and predictability must be augmented by the study of how we can best deal with uncertainty, unpredictability and emergent causality. Accordingly, the study of complexity in health services and systems requires new standards of research quality, namely (for example) rich theorising, generative learning, and pragmatic adaptation to changing contexts. This framing of complexity-informed health services research provides a backdrop for a new collection of empirical studies. Each of the initial five papers in this collection illustrates, in different ways, the value of theoretically grounded, methodologically pluralistic, flexible and adaptive study designs. We propose an agenda for future research and invite researchers to contribute to this on-going series.

摘要

复杂性在卫生服务研究中虽然被广泛讨论,但研究得还不够充分。尽管复杂系统作为一种分析视角的重要性日益得到认可,但许多研究人员仍在使用假设封闭系统的方法,这些方法通常认为可以进行预测性研究,尤其是控制实验。我们认为,在以动态变化的相互关系和紧张关系为特征的开放系统中,基于线性和可预测性的传统研究设计必须辅之以研究如何最好地应对不确定性、不可预测性和涌现因果关系。因此,卫生服务和系统的复杂性研究需要新的研究质量标准,例如丰富的理论化、生成性学习以及对不断变化的背景的务实适应。这种以复杂性为导向的卫生服务研究框架为一组新的实证研究提供了背景。本集的前五篇初始论文以不同的方式说明了理论基础扎实、方法多元化、灵活和适应性强的研究设计的价值。我们提出了未来研究的议程,并邀请研究人员为这一系列研究做出贡献。

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