This is the first draft of an Editorial I wrote for the open access African Journal of Health Professions Education, which will be coming out soon.
Health and education systems are increasingly recognised as complex adaptive systems that are characterised by high levels of uncertainty and constant change as a result of rich, non-linear interactions (Fraser & Greenhalgh, 2001; Bleakley, 2010). This means that complex systems are inherently ambiguous and uncertain, and that they lack predictable outcomes or clear boundaries. As health and education systems have become more complex and integrated at the beginning of the 21st century, it is no longer possible for single individuals – or even single disciplines – to work effectively within these systems (Frenk et al., 2010).
The problems generated by complex systems have been called wicked problems and are not simply difficult to solve, they are impossible to solve (Conklin, 2001; Ritchey, 2013). They’re “messy, devious, and they fight back when you try to deal with them.” (Ritchey, 2013). They’re the kinds of problems where different stakeholders have different frameworks for even trying to describe the problem, and where the constraints and resources necessary to work on the problem change over time (Conklin, 2001).
Wicked problems are also about people, vested interests and politics – making them very subjective, which is why they do not have stable problem formulations, pre-defined solution concepts, and why their outcomes are unpredictable (Ritchey, 2013). Even though we cannot solve wicked problems we can move them forward by learning how to adapt to change, generate new knowledge, and continue improving performance (Fraser & Greenhalgh, 2001). The uncertainty of complex systems is therefore something that we need to be comfortable with, learn to engage with, and be curious about. Wicked problems are not amenable to resolution through formal, structured methods; we must rather adapt to working within them.
The ability to drive progress in complex systems is a function of the ability to generate and connect ideas across groups and disciplines, and then implement new processes based on them. Not only do these activities take time, they are highly social as success often depends on who we work with (Jarche, 2016). In other words, teams are not only important for effective work but also for the kinds of generative, creative work that 21st century problems require. The ability to work in effective, interdisciplinary and creative teams is what we need to address the health problems of the future.
If the knowledge and skills required to work with wicked problems in complex systems are so diverse that it is impossible for a single individual or profession to make any appreciable impact, it is clear that we need teams that work across disciplinary boundaries. Therefore, interprofessional education is one possible strategy that we can follow to try and develop the requisite competencies for working within complex systems. These competencies include – among others – the ability to develop relationships, emotional intelligence, group work, communication and self-management, all of which are difficult to develop and assess within students (Knight & Page, 2007).
In fact, higher education is not at all well-positioned to help students develop the competencies that enable them to work with wicked problems in complex systems. Social learning theories that can help practitioners become more effective in non-linear, dynamic systems through inter-professionalism and shared tolerance of ambiguity are generally absent, especially in medical education (Bleakley, 2010). Adopting these approaches at the programme level in health professions education requires the kind of radical change that traditional health and education systems are highly resistant to. (Frenk et al., 2010). If we want to make any real progress in improving health and education outcomes in an increasingly complex world, we must start taking seriously the idea that radical curriculum reform is not only indicated, but required.
Bleakley, A. (2010). Blunting Occam’s razor: aligning medical education with studies of complexity. Journal of Evaluation in Clinical Practice, 16(4), 849–855. http://doi.org/10.1111/j.1365-2753.2010.01498.x
Conklin, J. (2001). “Wicked Problems and Social Complexity.” CogNexus Institute. [Online]. Available from: http://cognexus.org/wpf/wickedproblems.pdf
Fraser, S. W., & Greenhalgh, T. (2001). Coping with complexity: educating for capability. BMJ, 323, 799–803.
Frenk, J., Chen, L., Bhutta, Z. A., Cohen, J., Crisp, N., Evans, T., … Zurayk, H. (2010). Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. The Lancet, 376(9756), 1923–1958. http://doi.org/10.1016/S0140-6736(10)61854-5
Jarche, H. (2016). valued work is not standardized.
Knight, P. T., & Page, A. (2007). The assessment of “wicked” competences: A report to the Practice-based Professional Learning Centre for excellence in teaching and learning in the Open University. Retrieved from www.open.ac.uk/cetl-workspace/cetlcontent/…/460d21bd645f8.pdf
Ritchey, T. (2013). Wicked problems: Modelling Social Messes with Morphological Analysis. Acta Morphologica Generalis, Vol. 2 No. 1.