Table 1 Traditional versus new paradigm approaches to researching health services and systems
From: Studying complexity in health services research: desperately seeking an overdue paradigm shift
Traditional approach | New paradigm (complexity-informed) approach | |
|---|---|---|
Goal of research | Establishing the truth, universal and enduring; finding solutions to well-defined problems | Exploring tensions; generating insights and wisdom; exposing multiple perspectives; viewing complex systems as moving targets |
Assumed model of causality | Linear, cause-and-effect causality (perhaps incorporating mediators and moderators) | Emergent causality: multiple interacting influences account for a particular outcome but none can be said to have a fixed ‘effect size’ |
Typical format of research question | “What is the effect size of the intervention on the predefined outcome, and is it statistically significant?” | “What combination of influences has generated this phenomenon? What does the intervention of interest contribute? What happens to the system and its actors if we intervene in a particular way? What are the unintended consequences elsewhere in the system?” |
Mode of representation | Attempt to represent research in one authoritative voice | Attempt to illustrate the plurality of voices inherent in the research and phenomena under study |
Good research is characterised by | Methodological ‘rigour’, i.e. strict application of structured and standardised design, conventional approaches to generalisability and validity | Strong theory, flexible methods, pragmatic adaptation to emerging circumstances, contribution to generative learning and theoretical transferability |
Purpose of theorising | Disjunctive: simplification and abstraction; breaking problems down into analysable parts | Conjunctive: drawing parts of the problem together to produce a rich, nuanced picture of what is going on and why |
Approach to data | Research should continue until data collection is complete | Data will never be complete or perfect; decisions often need to be made in situations of incomplete or contested data |
Analytic focus | Dualisms: A versus B; influence of X on Y | Dualities: inter-relationships and dynamic tensions between A, B, C and other emergent aspects |