Talking it better: Conversations and normative complexity in healthcare improvement

Alan Cribb*, Vikki Entwistle, Polly Mitchell

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

9 Citations (Scopus)
2 Downloads (Pure)


In this paper, we consider the role of conversations in contributing to healthcare quality improvement. More specifically, we suggest that conversations can be important in responding to what we call 'normative complexity'. As well as reflecting on the value of conversations, the aim is to introduce the dimension of normative complexity as something that requires theoretical and practical attention alongside the more recognised challenges of complex systems, which we label, for short, as 'explanatory complexity'. In brief, normative complexity relates to the inherent difficulty of deciding what kinds of changes are 'improvements' or, more broadly, what is valuable in healthcare. We suggest that explanatory and normative complexity intersect and that anyone interested in healthcare improvement needs to be sensitive to both. After briefly introducing the idea of normative complexity, we consider some contrasting examples of conversations, reflecting on how they do and might contribute to healthcare quality. We discuss both conversations that are deliberately organised and facilitated ('orchestrated conversations') and more informally occurring and routine conversations. In the first half of the paper, we draw on some examples of orchestrated and routine conversations to open up these issues. In the second half of the paper, we bring some more theoretical lenses to bear on both conversations and normative complexity, summarise what we take to be the value of conversations and draw together some of the implications of our discussion. In summary, we argue that conversations can play a crucial role in negotiating the normative complexity of healthcare quality improvement because of their capacity to hold together a plurality of perspectives, to contribute and respond to emergence and to help underpin institutional conditions for empathy and imagination.

Original languageEnglish
Pages (from-to)85-93
Number of pages9
JournalMedical humanities
Issue number1
Early online date25 May 2021
Publication statusPublished - Mar 2022

Bibliographical note

Funding This study was funded by Wellcome Trust (grant number 209811/Z/17/Z)


  • health policy
  • inter-professional education
  • medical ethics/bioethics
  • philosophy of medicine/health care
  • social science


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