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Blurred lines: Transversal skills for managing complexity in healthcare

Each generation of human being is convinced that their time is one of the most difficult and complex.

The difference in what is happening with our society today, says Joan Cornet Prat, Board Member and Director of the Digital Health Observatory, ECHAlliance and Technical Engineer and Psychologist,  is that we face a new paradigm in the form of the digital revolution. 

In ancestral societies, until a few decades ago, there were social and religious norms that in one way or another gave or intended to give meaning to life. The societies about which we are relatively well informed (for example Egyptian, Greek and Roman) were maintained for long periods thanks to their structure of ‘pyramidal’ power, obligatory religion, and a  society with very well differentiated classes as well as an abundance of slaves with no rights.

Throughout history this approach was reproduced with certain modifications. Occasionally, there would be adjustments, for example between 1777 and 1804, slavery was outlawed in the north of the United States. Denmark abandoned the slave trade in 1792 followed by Britain, in 1807. But the slave trade continued. Finally, slavery would end up being banned in the United States in 1863, in Cuba, in 1886; and in Brazil, in 1888. (extract from Wikipedia). These approaches organized society in a very rigid structures.

A Perfect Storm

In 1950 worldwide there were 2.5 billion inhabitants. Bt 2018 we had 7.6 billion and it is expected that by 2050 there will be 9.7 billion. In a 100 year period the world population will have increased by a staggering 7.2 billion inhabitants!

This is a perfect storm. We are seeing:

  • Extraordinary demographic increase worldwide,
  • Western societies that increasingly accept less pyramidal structures,
  • a loss of influence of religions in the lives of individuals,
  • a clamor for equality and freedom.

It coincides with:

  • the depletion of the neoliberal economic model,
  • the progressive disrepute of politics and the return of populism.

A new paradigm for humanity

The situation, with the interactive advent of the digital revolution, involves a new paradigm for  humanity. An extremely complex situation in which you must develop new skills and abilities both personal and professional in order to manage properly.

It is not merely about knowing how to use the new technologies , it is about how we incorporate ourselves within the transformation of organizations, the improvement of cities, the ability to increase the well-being of citizens, how we dynamize and innovate professionals, how we educate our children better and how we deal with the personal and professional challenges of the world we live in.

There are two sectors where this will have the greatest impact and these are, curiously, the two sectors that remain a prudent distance from the new paradigm. These are:

  • the educational model and
  • the provision of health and social services.

The educational model in Western countries has evolved little in the course of the last 50 years. It is true that there has been reform of curricula, but fundamentally it is the same model: a teacher who teaches and students who must learn by rote, en-masse.


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The health sector has been more dynamic. It has been an innovative sector thanks to the contributions of the pharmaceutical industry, the medical device industry, and the high motivation of the health professionals to be constantly trained in order to improve patient health.

Building blocks for transformation

This, however, means that in the face of the complexity of this new paradigm the health professionals within a sector will have to develop new skills and capacities to develop their clinical practice and support permanent transformation. It is what we call ‘transversal skills’.

Increasingly, health care professionals need to apply adaptive problem-solving skills to respond to complex and non-routine patient care issues, while working in complex, multi-disciplinary and frequently stressful occupational environments. In future years, countries will need resilient and flexible health workers who possess technical and clinical skills, alongside cognitive, self-awareness and social skills that will enable them to monitor and assess the situation, make decisions, take a leadership role, and communicate and co-ordinate their actions within a team in order to achieve high levels of patient safety and efficiency, as well as to assure their own safety and job satisfaction.

Accepting complexity

In 2001, Plsek and Greenhalgh edited a series of articles in the British Medical Journal, introducing the topic of complexity [1] and applied complexity principles to clinical care [2], leadership and management [3] and lifelong learning [4]. Despite the academic impact, there is still much to do in order to see a paradigm shift into the clinical practice.

Perhaps is time to revisit the original question asked by the 2001 British Medical Journal series: “What is complexity and what are its implications for clinical practice, research, service organisation and professional education?”

Complexity is described as “a dynamic and constantly emerging set of processes and objects that not only interact with each other, but come to be defined by those interactions” [5]

Law and Mol were right to suggest that “We need other ways of relating to complexity, other ways for complexity to be accepted, produced, or performed” (6)

How do we define skills?

Growing complexity

In the case of health organizations and their healthcare professionals, it is necessary to deal with two complexities, society, as pointed out before, and the health system itself, with its multiple stakeholders. Without a doubt, the economic, social and political environment has an impact on the patient’s care. In turn there is a growing complexity of the processes of attention to the patient, to work in the integral attention which implies a multidisciplinary work, to follow established guidelines, to reach the objectives proposed by the organization of health, etc.

In turn, the clinical professional must be able to manage the new technological arsenal:

  • Big Data,
  • Artificial intelligence,
  • Precision Medicine,
  • Robotics,
  • Blockchain,
  • Patient’s Remote Monitoring tools etc.

And don’t forget the need of a solid training in cybersecurity topics!

So, we have a complex challenge to face in the coming years. Are you ready?

Information and sources

  1. Plsek PE, Greenhalgh T. Complexity science – the challenge of complexity in health care. BMJ. 2001;323(7313):625–8.
  2. Wilson T, Holt T, Greenhalgh T. Complexity and clinical care. BMJ. 2001; 323(7314):685–8.
  3. Plsek PE, Wilson T. Complexity, leadership, and management in healthcare organisations. BMJ. 2001;323(7315):746–9
  4. Fraser SW, Greenhalgh T. Complexity science – coping with complexity: educating for capability. BMJ. 2001;323(7316):799–803
  5. Cohn S, Clinch M, Bunn C, Stronge P. Entangled complexity: why complex interventions are just not complicated enough. J Health Serv Res Policy. 2013;18(1):40–3
  6. Law J, Mol A-M. Complexities: An Introduction. In: Law J, Mol A-M, editors. Complexities: Social Studies of Knowledge Practices. Durham: Duke University Press; 2002. p. 1 –22.
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