WHO symposium on modelling and optimizing the health and care workforce: Complexity Thinking for Equitable and Resilient Healthcare Workforces

I would like to thank Tomas Zapata, Cris Scotter, and their team in the Unit of Health Workforce and Health Services in the WHO Regional Office for Europe (Copenhagen) for the opportunity to present at the WHO symposium on modelling and optimizing the health and care workforce.

OVERVIEW OF WHO CONFERENCE

On 28–30 April, WHO/Europe convened a diverse group of experts for a 3-day symposium at UN City, Copenhagen, focused on advancing innovative practices in health workforce modelling and optimization. Bringing together thought leaders, policy experts, technical specialists and practitioners across sectors, this event will provide a platform to explore the complexities of workforce planning in a rapidly evolving landscape. The event was organized in partnership with the Government of Ireland, Socialstyrelsen (National Board of Health and Welfare of Sweden) and Durham University. With health systems facing acute workforce shortages, shifting service demands and the need for more flexible, resilient health services, optimizing workforce planning with data-driven strategies has never been more critical.

 

CLICK HERE for a PDF of my presentation

 

CLICK HERE for an overview of the conference

CLICK HERE for an overview of the programme

CLICK HERE to watch some of the main talks and plenaries

 

CLICK HERE to go to my map of the complexity sciences

 

CLICK HERE to see COMPLEX-IT, our interdisciplinary methods platform for nontechnical users in health policy, including systems mapping, machine learning, simulation, cluster analysis, data forecasting and data visualization.

OVERVIEW OF MY TALK:

 

WORKFORCE FUTURES RE-IMAGINED:

Complexity Thinking for Equitable and Resilient Healthcare Workforce(s)

 

Why Complexity?

I was asked to be part of the opening plenary, which set the theme for the conference, by talking about the value of the complexity sciences and systems thinking, as well as transdisciplinary modelling approaches, for addressing the current challenges facing the healthcare workforce throughout the world.

 

The main aim of my talk was not to offer another technocratic fix, but to provoke a deeper conversation about the paradigms shaping our approach to the healthcare workforce crisis, and why they continue to fall short – as viewed through the lens of the complexity sciences and systems thinking (See online map of the complexity sciences).

For over sixty years, the social and health sciences have documented the same litany of systemic failures: health inequities, chronic under-funding, workforce burnout, structural discrimination, and slow policy responsiveness, among others. These are not new problems. They are persistent problems — because they are complex. They are “wicked” in the truest sense: entangled in political, cultural, economic, and institutional dynamics that resist linear, reductionist solutions.

 

And yet, our modelling practices too often remain stuck in epistemic inertia. The same people in the same rooms using the same tools and asking the same questions, resulting in the same limited answers. The future, however, demands a different grammar — one that complexity science is uniquely positioned to offer.

 

We need to disruption the path-dependent inertia of our present trajectory.

 

As Lasse Gerrits and I outline in The Atlas of Social Complexity, disrupting the healthcare systems of different counties is a wicked problem, largely because healthcare workforces are complex socio-ecological system: historically contingent, politically contested, shaped by nested and emergent dynamics, and riddled with nonlinear feedback loops. These systems demand a rethinking of how we model, plan, and govern workforce futures.

 

Complexity thinking reframes healthcare systems and healthcare workforces as socio-ecological systems — nested, emergent, and historically contingent. They are not machines to be optimised but living systems to be understood, shaped, and co-evolved. In this framing, the healthcare workforce becomes a system within systems — shaped by feedback loops, power relations, and path-dependent dynamics that operate across local and global scales.

 

Central to my keynote was the value of case-based complexity, an interdisciplinary methodological approach grounded in the work of David Byrne and Charles Ragin (See Sage Handbook of Case-Based Methods). It offers a shift away from universal laws and one-size-fits-all projections, toward a configurational view of causality — where outcomes arise from complex interactions among social, institutional, and ecological factors.

 

Equifinality, multifinality, and causal asymmetry are not abstract concepts. They are essential tools for rethinking workforce modelling. What works in one country, region, or profession may not work elsewhere, and may even cause harm. 

• Multifinality: how similar paths lead to different conclusions. 
• Equifinality: how different paths can lead to the same conclusion. 
• Causal asymmetry: how what works in one setting might fail in another.

Health workforce ecosystems are ensembles of cases, each requiring situated, context-sensitive interventions. Complexity, in this view, is not a complication. It is a place-based contextual truth.

 

This epistemological shift carries profound implications. It calls for modelling practices that are not only computationally and statistically sophisticated, but also reflexive, co-productive, and ethically aware. It demands interdisciplinary platforms that integrate qualitative insight, lived experience, and participatory governance. It insists that equity is not an afterthought but an emergent property of system design — and that justice requires we see discrimination not as deviance but as a reproducible system output.

 

For example, Complexity resists heroic models of leadership. Instead, leadership emerges from distributed systems, collaborative processes, and shared sensemaking. The myth of top-down control must give way to adaptive, ethical governance. Going further, discrimination is not an anomaly but a systemic output. A complexity-informed equity lens reveals how racism, sexism, and other forms of power and injustices are reproduced institutionally. Equity must be built into the very fabric of modelling, not as consultation, but as co-authorship.

 

Ultimately, my message was simple: if we want to build health workforce systems that are resilient, equitable, and future-ready, we must let go of outdated paradigms. Complexity is not a buzzword. It is a different way of knowing and of acting. The question now is whether we have the courage to embrace it.