Abstract
This commentary addresses two points raised by Kitson and colleagues’ article. First, increasing interest in applying
the Complexity Theory lens in healthcare needs further systematic work to create some commonality between
concepts used. Second, our need to adopt a better understanding of how these systems organise so we can change
the systems overall behaviour, creates a paradox. We seek to manipulate systems that self-organise and follow their
own internal rules. Although, our actions may impact and indeed meet some of our objectives, system behaviour
will always emerge with unpredictable consequences. Likewise, outcomes at the aggregated level of the system never
reaches an optimal point as defined by the ‘external controller.’ Kitson and colleagues’ theoretical model may struggle
to resolve the paradox of gaining control over the multiple knowledge translation (KT) systems covered by the model,
because theoretically these systems retain control under the principle of self-organisation. That is not to suggest that
individual agents cannot influence system dynamics just that the desired outcome cannot be guaranteed. Indeed, for
systems to change they will need strong incentives