title: Why are organisations that provide healthcare services fuzzy?
abstract: BACKGROUND
  Healthcare organisations are an enigma to many people inand outside the service. Organisational fuzziness is a common state, characterised by a lack of clarity, lack of awareness, lack of organisational knowledge, and the reliance on practice and custom instead of transparency.
  
  
  OBJECTIVE
  The objective of this study was to obtain a better understanding of what causes this fuzziness and provide an actionable description of fuzzy organisations. Such a description is essential to managing and preventing organisational fuzziness.
  
  
  METHODS
  We used a longitudinal case study in an integrated healthand social care organisation to obtain a thorough understanding of how the organisation functions. These indepth insights allowed the identification of three generators of fuzziness.
  
  
  RESULTS
  We found that the three main generators of organisational fuzziness are change, informal organisation and complexity. Organisational fuzziness is thus partly due to the inherent complexities of human systems. However, also continuous change and the inability of the system to adapt its formal structures resulted in structures deteriorating or no longer being appropriate.
  
  
  CONCLUSIONS
  Existing approaches to explain unclear or absent structures in healthcare organisations by describing these organisations as complex adaptive systems (CAS) are too simplistic. While aspects relating to people and their interactions are indeed complex, fuzziness of structural aspects are often the result of continuous change and insufficient organisational capacity to adapt to it.
authors.affiliation: Engineering Design Centre, University of Cambridge.
authors.forename: Eva-Maria
authors.initials: EM
authors.lastname: Hempe
keywords: Complexity; change; complex adaptive systems; healthcare organisations; healthcare services; service design