The influence of complexity: a bibliometric analysis of complexity science in healthcare

Abstract

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.

Keywords: bibliometrics; complex adaptive systems; complexity science; health care; healthcare; review.

Figure 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram of search strategy.

Figure 2

Global trends for publishing articles on complexity science applied to healthcare.

Figure 3

Trends over time in the types of articles published on complexity science applied to healthcare. Note data collected mid-2018.

Figure 4

Trend over time in the publications of complexity science applied to healthcare by topic theme.

Figure 5

Sociogram of index references for complexity science applied to healthcare. Each circle (node) is representative of a research output. The size of node is indicative of in-degree (larger nodes indicate a higher number of references towards the output as an index). Colour of node is indicative of the topic theme. * indicates equal levels of in-degree for corresponding rank.