Complexity and health care: Health practitioner workforce services, roles, skills and training, to respond to patients with complex needs

Abstract

Complexity has a profound effect on healthcare and outcomes. It is characterised by multiple dimensions, including co-occurring or multifaceted medical conditions, age, frailty, socio-economic realities, culture, environment, behaviour and systems factors. This purposive, thematic review describes aspects of health care complexity of relevance to the health practitioner workforce and services, particularly skill development and training. It examines some key factors contributing to complexity and elucidates some of the challenges and potential in responding to patients with complex needs. The review applies two useful conceptualisations to the topic. First, drawing from management science literature, it identifies health care complexity as a “wicked problem”. This indicates that complex health issues comprise multiple layers and dimensions, that they are associated with fragmentation and that their resolution frequently requires a diversity of players, different levels of response and a variety of methods of response, which in itself adds increasing complexity. Second the review uses the WHO International Classification of Functioning, Disability and Health (ICF) as a way of categorising some of the dimensions of complexity. The ICF depicts a comprehensive bio-psycho-social model of health and functioning and reflects dimensions and interactions that are influential in health care complexity at individual and systems levels.