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The influence of complexity: a bibliometric analysis of complexity science in healthcare
  1. Kate Churruca,
  2. Chiara Pomare,
  3. Louise A Ellis,
  4. Janet C Long,
  5. Jeffrey Braithwaite
  1. Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
  1. Correspondence to Dr Kate Churruca; kate.churruca{at}


Objectives To analyse trends in the academic literature applying complexity science to healthcare, focusing specifically on bibliometric characteristics and indicators of influence.

Design This study reports a bibliometric analysis via a systematic search of the academic literature applying complexity science to healthcare.

Method A search of four academic databases was performed on 19 April 2018. Article details were downloaded and screened against inclusion criteria (peer-reviewed journal articles applying complexity science to healthcare). Publication and content data were then collected from included articles, with analysis focusing on trends over time in the types and topics of articles, and where they are published. We also analysed the influence of this body of work through citation and network analyses.

Results Articles on complexity science in healthcare were published in 268 journals, though a much smaller subset was responsible for a substantial proportion of this literature. USA contributed the largest number of articles, followed by the UK, Canada and Australia. Over time, the number of empirical and review articles increased, relative to non-empirical contributions. However, in general, non-empirical literature was more influential, with a series of introductory conceptual papers being the most influential based on both overall citations and their use as index references within a citation network. The most common topics of focus were health systems and organisations generally, and education, with recent uptake in research, policy, and change and improvement.

Conclusions This study identified changes in the types of articles on complexity science in healthcare published over time, and their content. There was evidence to suggest a shift from conceptual work to the application of concrete improvement strategies and increasingly in-depth examination of complex healthcare systems. We also identified variation in the influence of this literature at article level, and to a lesser extent by topic of focus.

  • complexity science
  • healthcare
  • bibliometrics
  • review
  • complex adaptive systems
  • health care

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  • Contributors KC had the original idea for the article and devised the search strategy with support from LAE, JL and JB. KC oversaw the search, and conducted the title/abstract review and analysis with assistance from CP and LAE. CP performed the network analysis of influence. KC drafted the manuscript. CP, LAE, JL and JB critically revised the manuscript. All authors agreed upon the final version of the manuscript.

  • Funding JB is supported by multiple grants, including the National Health and Medical Research Council (NHMRC) Partnership Grant for Health Systems Sustainability (ID: 9100002).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data will be shared upon request to the first author.

  • Patient consent for publication Not required.