Introduction: how we got here

This introductory chapter traces the development of the five previous volumes in this book series and establishes how the current book came into being. Using Charles E Lindblom’s original idea, expressed in articles published in 1959 and 1979, we canvas how muddling through with purpose continues to have great relevance in explaining how work is enacted, and fits well as a way of explaining resilient health care. Lindblom proposes a distinction between mechanistic, linear, simplistic views of work and a view of work as complex and uncertain and always practised in less-than-perfect circumstances where human actors must make compromises and trade-offs. It is this second account of work, which sees the intricacies, multi-faceted nature and unpredictable aspects of health care, that we explore in this chapter, helping explain how people continually adjust and flex and make incremental gains to achieve goals of benefit to patients across health care ecosystems.