Schools as social complex adaptive systems: A new way to understand the challenges of introducing the health promoting schools concept

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Abstract

Achieving system-wide implementation of health promotion programs in schools and sustaining both the program and its health related benefits have proved challenging. This paper reports on a qualitative study examining the implementation of health promoting schools programs in primary schools in Sydney, Australia. It draw upon insights from systems science to examine the relevance and usefulness of the concept of “complex adaptive systems” as a framework to better understand ways in which health promoting school interventions could be introduced and sustained. The primary data for the study were collected by semi-structured interviews with 26 school principals and teachers. Additional information was extracted from publicly available school management plans and annual reports. We examined the data from these sources to determine whether schools exhibit characteristics of complex adaptive systems. The results confirmed that schools do exhibit most, but not all of the characteristics of social complex adaptive systems, and exhibit significant differences with artificial and natural systems. Understanding schools as social complex adaptive systems may help to explain some of the challenges of introducing and sustaining change in schools. These insights may, in turn, lead us to adopt more sophisticated approaches to the diffusion of new programs in school systems that account for the diverse, complex and context specific nature of individual school systems.

Introduction

School heath programs over the last four decades have achieved some well documented successes in improving knowledge and health related skills, and in changing health behaviours such as smoking, food choices and physical activity (Lister-Sharp, Chapman, Stewart-Brown, & Sowden, 1999; Stewart-Brown, 2006, WHO, 1996). These successes have involved the development of sophisticated health education curricula and support materials, and recognition of the important influence of the wider school environment on health and health behaviour. In response to this improved understanding of successful interventions a more holistic approach to school health programs has evolved in the form of the health promoting schools concept (Nutbeam, 1992, WHO, 1996). This methodology draws upon the theoretical underpinnings and practical experience of what WHO has referred to as a “settings” approach to health promotion. In the case of schools, this involves combining traditional classroom education with actions to improve the physical and social environment, school policies, and the relationship between school, home and local community in ways that promote health. As a consequence of WHO endorsement and advocacy this comprehensive, holistic approach to school health promotion has been adopted with enthusiasm around the world. Disappointingly, as with previous school health programs, achieving successful implementation and sustaining the positive benefits has proven to be challenging in evolving, complex school systems. After more than a decade, the implementation of health promoting schools concept still lags far behind the vision (Lister-Sharp et al., 1999, Rowling and Jeffreys, 2006, St Leger and Nutbeam, 2000, Stewart-Brown, 2006).

Progressively, those involved in public health intervention research have acknowledged and explored the complexity of interventions that are designed to produce change at multiple levels (Resnicow and Page, 2008, Shiell et al., 2008). Better understanding schools as “systems”, and better understanding of the operation of that system offers scope for improvement in the introduction and management of multi-level interventions in schools (Bond, Glover, Godfery, Bulter, & Patton, 2001).

Building upon the historical shifts in school health practice and emerging understanding of a “systems” approach to health interventions, this paper reports on an examination of schools as complex systems. Specifically, the study has attempted to draw upon insights from systems science by examining the relevance and usefulness of the concept of “complex adaptive systems” as an approach to better understanding ways in which health promoting school interventions could be introduced and sustained. The emerging field of “complexity science” offers an approach to examining change in complex systems.

Section snippets

Complex systems and complex adaptive systems

There are different categories for systems based on the degree of their complexity. Kurtz and Snowden (2003) divide systems into four groups of simple, complicated, complex and chaos systems depending on the degree to which cause-effect relationships can be predicted. Complex and simple systems do have similarities in that both are systems formed by a set of connected components and a set of rules. Axelrod and Cohen (2000) divide complex systems into two categories – adaptive and non adaptive,

Key characteristics of complex adaptive systems

Complex adaptive systems are nested systems made up of diverse agents that can often also be considered as systems in their own right (Axelrod & Cohen, 2000). Each system is a part of something bigger, (Funtowicz and Ravetz, 1994, Holland, 1998). Thus, depending on the starting point, each system can be a sub-system for a bigger system, and a supra system for a smaller system. These sub-systems and supra systems can be complex and adaptive themselves. For example, a hospital can be viewed as a

Methods

Babbie (2006) has advocated for the use of social research methods which help our understanding of human behavior by uncovering the rules governing human and organisational behaviour. This study has been positioned to examine the acts of key agents in schools (teachers and school principals) as a method of examining whether schools exhibit characteristics of complex adaptive systems.

In general quantitative methods are more compatible with studying simple systems and relationships between

Schools' components and structure

Information available from school management plans and annual reports indicate that schools exhibit the type of nested structure that characterises a complex adaptive system. Schools are systems shaped from numerous and heterogeneous components often categorized in groups – sub-systems of different agents as diverse as principal and management staff, teaching staff administrative and support staff, students and their parents. There are also formally structured components such as school

Discussion

Utilising complex adaptive theory to guide enquiry into a discrete phenomenon (such as a health promoting school) is a challenging task, in part due to the complexity of the theory itself, and in part because of the continuing uncertainty on a clear definition of complex adaptive systems (Rickles et al., 2007, Wallis, 2008). While there has been a recognition of complexity, and steady increase in the use of complexity theory in the study of health care and public health interventions (Keshavarz

Conclusion

The findings of this study needs to be further tested but do have the potential to lead us to new directions in practice by suggesting strategies which are compatible with the complex and adaptive nature of schools. The findings suggest that social complex adaptive systems are distinctly different from other (natural and artificial) systems, and that these differences matter as they are highly relevant to managing change in systems. While it appears that it is the time for an important paradigm

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