title: Application of simplified Complexity Theory concepts for healthcare social systems to explain the implementation of evidence into practice.
abstract: OBJECTIVE
  To examine the application of core concepts from Complexity Theory to explain the findings from a process evaluation undertaken in a trial evaluating implementation strategies for recommendations about reducing surgical fasting times.
  
  
  BACKGROUND
  The proliferation of evidence-based guidance requires a greater focus on its implementation. Theory is required to explain the complex processes across the multiple healthcare organizational levels. This social healthcare context involves the interaction between professionals, patients and the organizational systems in care delivery. Complexity Theory may provide an explanatory framework to explain the complexities inherent in implementation in social healthcare contexts.
  
  
  METHODS
  A secondary thematic analysis of qualitative process evaluation data informed by Complexity Theory.
  
  
  METHODS
  Seminal texts applying Complexity Theory to the social context were annotated, key concepts extracted and core Complexity Theory concepts identified. These core concepts were applied as a theoretical lens to provide an explanation of themes from a process evaluation of a trial evaluating the implementation of strategies to reduce surgical fasting times. Sampled substantive texts provided a representative spread of theoretical development and application of Complexity Theory from late 1990's-2013 in social science, healthcare, management and philosophy.
  
  
  RESULTS
  Five Complexity Theory core concepts extracted were 'self-organization', 'interaction', 'emergence', 'system history' and 'temporality'. Application of these concepts suggests routine surgical fasting practice is habituated in the social healthcare system and therefore it cannot easily be reversed. A reduction to fasting times requires an incentivised new approach to emerge in the surgical system's priority of completing the operating list.
  
  
  CONCLUSIONS
  The application of Complexity Theory provides a useful explanation for resistance to change fasting practice. Its utility in implementation research warrants further attention and evaluation.
authors.affiliation: The Cochrane Editorial Unit, The Cochrane Collaboration, London, UK.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Chandler
authors.affiliation: School of Healthcare Sciences, Bangor University, UK.
authors.forename: Jo
authors.initials: J
authors.lastname: Rycroft-Malone
authors.affiliation: Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Hawkes
authors.affiliation: School of Social Sciences, Bangor University, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Noyes
mesh_terms: D003695:Delivery of Health Care / Q000592:standards*; D055317:Evidence-Based Practice / Q000592:standards*; D005215:Fasting; D006801:Humans; D009742:Nursing Theory; D015279:Organizational Culture; D009937:Organizational Objectives; D017410:Practice Guidelines as Topic
keywords: Complexity Theory; controlled trial; fasting; guideline; health and social system; implementation; nursing; process evaluation