Complexity and clinical governance: using the insights to develop the strategy

There is increasing interest in complexity as an explanatory model to help understand how health care organisations operate and change. In this article, we present a brief introduction to some of the basic ideas in complexity and illustrate how these might be relevant to the process of implementing clinical governance. The implementation of clinical governance can be seen as a complex adaptive system: as such, we must accept that uncertainty and unpredictability are inescapable. This makes life uncomfortable for managers, but an understanding of how complex adpative systems work helps us explore a range or management styles and practices, depending on how the 'system' - in this case the implementation of clinical governance - is developing.