Professor of Sociology Brian Castellani delivered an opening address at the World Health Organization’s (WHO) Europe Symposium on Health Workforce Modelling for Action. The theme of the symposium was ‘Workforce Futures Reimagined’ and took place in Copenhagen on 28-30 April.
As a health sociologist and methodologist, Brian’s address challenged conventional thinking and reframed the healthcare workforce crisis through the lens of the complexity sciences, systems with many interconnected parts that interact in unpredictable ways.
Professor Castellani said our healthcare systems are ‘failing their workforces’.
He highlighted the 'persistent and interlinked crises in our healthcare workforce' that continue despite years of research, funding and intervention. These crises span from health inequities and burnout to discrimination and climate impacts.
Professor Castellani suggested that, as recent researchers have highlighted globally, the disruptive power of science has diminished over the past 60 years, therefore failing to address the issues faced in healthcare workforces.
He said that the field has become ‘trapped in methodological silos, repeating familiar questions and reinforcing the very problems it aims to resolve.’
Professor Castellani added: ‘The healthcare workforce is a paradigmatic case of failure to disrupt the challenges it faces.’
Professor Castellani explained that healthcare reform fails because healthcare workforces are highly complex systems.
These systems tend to be historically rooted, politically fraught, and governed by complex feedback loops.
He called for a major rethink of how to model, plan, and govern workforce futures and suggested five key areas of focus:
Harness AI and Data Architecture: Healthcare workforces must shift from fragmented data to integrated intelligence. This means embedding AI into modelling systems to help align local realities with regional and global demands.
From Forecast to Foresight: Traditional demand models extrapolate from the past. Complexity demands the simulation of alternative scenario-based futures, co-produced with frontline workers and patients. Models must not only describe systems but become part of them.
Leadership as Emergent Property: Complexity resists top-down leadership. To achieve effective leadership in healthcare workforces, collaboration, shared understanding and ethical governance are key.
Equity as a System Design Outcome: Discrimination is not an anomaly but a systemic output. Equity must be built into the very fabric of modelling, not as consultation, but as co-authorship.
Case-Based Complexity: Professor Castellani’s case-based complexity approach sees health systems not as simple systems going in only one direction. Instead, they are made up of many different, interconnected systems, each shaped by its own social, economic, and institutional forces. Given this view, for modelling purposes, instead of searching for one-size-fits-all answers, case-based complexity helps us understand how similar conditions can lead to very different outcomes (multifinality), how different paths can lead to the same result (equifinality), and how what works in one setting might fail in another (causal asymmetry). It’s a way to make sense of the real-world diversity and unpredictability of health workforce systems.
Summing up these five points, Professor Castellani encouraged intellectual wondering. ‘You don’t need to be a complexity scientist to use these tools,’ he said. ‘We need to establish trusting systems in which learning and teamwork facilitate risk taking and change.’
Closing his address, Professor Castellani said: ‘If we want a healthy population, we need to ensure a healthy and valued workforce, which requires that we acknowledge the complexity they live with and work in to better help them co-manage the systemic challenges they face.’
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