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Investigating complex interventions
A complex intervention is some deliberately initiated process of operationalising a new technology, treatment modality, behavioural change, or organisational innovation within the bounds of a health care system. Complex interventions may invove many different components, interacting with each other and with already existing elements of a social system. They can be very complex indeed.
Deliberate initiation means that an intervention is: institutionally sanctioned; formally or informally defined; consciously planned; and intended to lead to a changed outcome. Initiators of a complex intervention may seek to change the ways that people think, act and organize themselves in health care, or they may seek to initiate a process with the intention of creating a new outcome. There are three core components of such interventions:
- Actors are the individuals and groups that encounter each other in health care settings. Complex interventions aimed at individuals and groups may take the form of attempts to change the ways that people behave, for example, in trials of strategies for making ‘expert patients’; or they may take the form of a new ways of defining, classifying, and speaking about a problem, for example, in therapeutic attempts to recast the experience of chronic pain. The aims of such interventions are often to change people’s behaviour and its intended outcomes.
- Objects are the institutionally sanctioned means by which knowledge and practice are enacted. Examples are established drug therapies, trial protocols, clinical guidelines and electronic medical records. Complex interventions relating to objects include trials of novel therapeutic agents and medical devices, and of decision-making tools and clinical guidelines. The aims of such interventions often include changing people’s expertise and actions.
- Contexts are the physical, organisational, institutional, and legislative structures that enable and constrain, and resource and realize, people and procedures. Complex interventions relating to context include trials of new professional roles, mechanisms that mediate between health care organisations and professional groups, and organisational structures. The aims of such interventions are often to change the ways that people enact procedures to achieve goals in health care (or other) settings.
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