Working Complexity designs patient-centred healthcare experiences that honour the depth of what people and their families go through — and make them work. Not simplified. Understood.
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 design within it — rapidly, sensitively, and with evidence at the centre.
Every engagement draws from 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 action is incomplete. We move from insight to pilot — designing and testing in real environments, learning fast, adjusting responsively. We produce things that actually work in the messy reality of healthcare delivery.
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 arrive with a predetermined answer. We work with the situation as it actually is — its contradictions, its partial information, its pressures of time and resources.
Our process is iterative, adaptive, 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.
We bring together expertise across clinical pathways, service design, behavioural science, organisational theory, and lived experience research — because no single lens is sufficient.
Deep engagement with the situation: stakeholder interviews, observation, data review, and systems mapping to understand the full assemblage before proposing anything.
Making meaning from what we find — identifying patterns, tensions, leverage points, and the experiences that most need redesigning. Evidence-based. Never rushed.
Designing at pace — creating testable versions of new processes, pathways, and environments. Low fidelity where appropriate; high fidelity where it matters.
Testing in real conditions with real people. Gathering signal. Adapting sensitively. Building towards something that actually holds under the pressure of everyday care.
Ensuring that change is organisationally owned and not dependent on our presence. Building capability and confidence for ongoing complexity work from within.
Co-designing care journeys with patients and families — from first symptom to long-term condition management.
Mapping actors, feedback loops, and emergent behaviours that conventional management tools cannot see.
Redesigning pathways from the perspective of lived experience — addressing the gaps data alone cannot capture.
Moving from insight to action with speed and sensitivity — building evidence for change in real environments.
Designing conditions for good judgement under pressure — not false precision, but honest inquiry.
Building lasting confidence to work with complexity from within — through coaching and embedded practice.
"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."
Every situation is different. We don't offer a brochure before we've listened. Tell us what you're facing and we'll start with an honest conversation about whether and how we can help.