We think about healthcare that honours the depth of what people and their families go through — and we do that thinking in the open. Not simplified. Understood.
An open working practice — a space for thinking about complex healthcare in public. Not a consultancy with a service to sell. A practice with thinking to share. What this becomes is still being worked out, and we say so.
We live in an era that reaches for simplification as its first response to complexity — reducing systems to flowcharts, people to pathways, and care to compliance metrics.
But the lived experience of illness — for the patient, the carer, the clinician — is irreducibly complex. It is emergent, relational, uncertain, and deeply human. No widget solves it.
Working Complexity exists to hold that complexity with the seriousness it deserves — to map it, make sense of it, and think clearly within it, with evidence at the centre.
Every piece of work draws on three inseparable capacities. None operates without the others.
We begin with rigorous inquiry. Drawing on systems thinking, complexity theory, and evidence-based methodology, we map the full assemblage of a situation — its actors, its tensions, its hidden structures. We do not rush past the hard questions.
Understanding without form stays abstract. We move from insight to something that can be tried — an argument, a framework, a probe — designed to be tested against real conditions, counter-evidence, and the cases it would rather avoid.
At the heart of everything is the person — the patient navigating diagnosis, the family holding vigil, the clinician carrying impossible decisions. We design for what it actually feels like to be inside these systems, not merely for how they should function on paper.
We don't start with an answer to sell. We start with a situation as it actually is — its contradictions, its partial information, the pressure of time and resource that any real care system runs under — and we think our way into it, in the open.
The method is iterative and evidence-anchored. We move between rapid sense-making and careful analysis, between whole-system thinking and the specific moment of a single patient encounter. The writing is where that thinking becomes legible — to us first, then to anyone who reads it.
It is also a genuine collaboration with Claude — not assistance, not generation, but a working practice we find worth naming. In a field that values honesty about how knowledge is made, that seems the right place to start.
Reading widely and watching closely. We sit with a problem — the literature, the data, the lived account — and map the full assemblage before forming a view.
Making meaning from what we find — the patterns, the tensions, the leverage points, the thing that does not fit. Evidence-based. Never rushed.
Turning a half-formed idea into an argument that can be read and challenged. Low fidelity where appropriate; high fidelity where it matters.
Putting the argument under pressure — against counter-evidence, against an advisory board that disagrees, against the cases it would rather avoid. We change our position when the work tells us to.
Writing it down, marking the revision, leaving the door open. Nothing here is final. The work is a practice, not a verdict.
Health systems are built around the hard event — and structurally blind to the slow drift that precedes it. What would it take to see the drift, and pay attention to it?
Clinical uncertainty is not one thing. Aleatory, epistemic, ontological, systemic, existential — and collapsing them into one is itself a system failure.
Politics and medicine make the same mistake: resolving the discomfort of not-knowing through authority rather than inquiry. The love of certainty is the problem, not the cure.
Health economics prices the uncertainty it can model and quietly zeroes the rest. We are asking what false certainty actually costs — and how you would measure it.
The carer's observation, the nurse's monthly call, the patient's own record — distributed sensing the system generates continuously and captures almost never.
Polynesian navigation, Talmudic dissent, indigenous fire. Older ways of working with genuine complexity — not as alternatives to rigour, but as forms of it.
These are open questions, not service lines. If one of them is your problem too, we'd be glad to talk.
"The patient is not an edge case.
The family is not overhead.
The clinician's uncertainty is not a failure.
These are the system."
Working Complexity · Design Principles · 2024
Working Complexity is the practice of Michael Baldwin — shaped by a career in and around healthcare, where trial data and market projections meet the people, families and clinicians behind the numbers.
The intellectual anchors are named openly. Dave Snowden's Cynefin framework, for telling the complicated from the complex. Complex adaptive systems, as the honest description of how healthcare behaves. Joan Tronto's ethics of care, as the reminder that the analytical and the moral are not separate stances.
Based in the United Kingdom. Working globally — with the NHS, charities, pharma and commissioners.
Why I have always been drawn to complexity — from a schoolboy's disappointment that Newton's laws were "too simple", through Cynefin and complex adaptive systems, to the question that matters most in health care: what matters to you?
Read the essay →
"I lost something.
I also gained something."
This is a space for thinking, and the business model is still being worked out — so this is not a pitch. If the writing speaks to you, or you're wrestling with something it touches, tell us. We'll start with an honest conversation, not a brochure.