Making Sense of Complexity: Reframing Healthcare Improvement Through Critical Systems Thinking and Practice

ABSTRACT Healthcare systems face increasingly complex challenges that defy linear, reductionist approaches to improvement. Traditional quality improvement methods commonly used in healthcare systems often fail to address the multidimensional, adaptive nature of complex problem situations. This paper argues that critical systems thinking (CST) and its practical application through critical systems practice (CSP) provide a more suitable foundation for navigating such complex challenges. Using the EPIC framework— Explore , Produce , Intervene , Check —CSP offers a structured yet flexible approach for systemic sensemaking and multimethodological action. Drawing on a case study in NHS mental health and primary care, the paper demonstrates how the Explore stage enabled stakeholders to make sense of complexity through systemic perspectives, visual methods and collaborative problem structuring. Findings indicate that CSP broadens the conception of improvement and offers a pragmatic pathway for healthcare leaders, professionals and practitioners to achieve contextually grounded systemic improvements in complex healthcare environments.