Working with value complexity in healthcare

In this paper, we argue for a rethinking of complexity in healthcare in terms of value complexity. Although widely adopted in healthcare, the positivist roots of complexity theory have thus far limited its applicability to understand the wicked nature of many healthcare challenges. We draw on a new pragmatist approach to contend that values are situated and embedded in practice, and demonstrate how values and practices co-develop in ways resembling complex systems. We employ this analytical lens in a secondary analysis of prior ethnographic and action research undertaken between 2010 and 2022 in the context of Dutch healthcare. These studies were conducted in the context of older person care and the (care) services for people with chronic diseases, disabilities, and mental illness. Based on our findings, we bring forward a layered conceptualization of value complexity. Additionally, we illustrate three ways in which practitioners and scholars manage value complexity: “working around,” “working against,” and “working with” complexity. We consider the (dis)advantages of each of these strategies. We conclude that “working with” complexity is difficult in practice yet provides untapped potential to responsibly manage value conflicts.