Where theorists and empiricists fear to tread: comparing and contrasting the interplays between complexity science and organisational cultural accounts of health care organisation

In organisational behaviour studies in health care settings, there has been much research and theory commenting on organisational and workplace cultures. More recently, work has been conducted to understand the features of health care as a complex adaptive system. As burgeoning areas of health services research, health care as complex adaptive systems, and organisational and workplace culture, have followed parallel paths. They have been studied in isolation, and there is little understanding of the interplay, if any, between them. It is time for
these paths to intercept, and for us to see whether, and if so the extent to which, the boundaries between these different paradigms are solid or permeable. In this study, first, we provide an overview of complexity science and organisational cultural conceptualisations of organisation. Then, we examine a group of 62 studies identified as measuring the association between culture and patient outcomes, drawn from a recent systematic review. The articles are
re-analysed to identify the features of complex adaptive systems that the study settings presented, with a view to traverse the boundaries between the two domains. We found considerable overlap between these constructs, and present the results of this re-analysis. We argue that there is a generalisable point to be made: theorists and empiricists in the organisational behaviour field might beneficially navigate across the boundaries in the field, as we attempt to do here, rather than perpetuate the divides that have created through academic specialisation and sub-specialisation.