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Abstract：
In this paper, we consider the role of conversations in contributing to healthcare quality improvement. More specifically, we suggest that conversations can be important in responding to what we call \'normative complexity\'. As well as reflecting on the value of conversations, the aim is to introduce the dimension of normative complexity as something that requires theoretical and practical attention alongside the more recognised challenges of complex systems, which we label, for short, as \'explanatory complexity\'. In brief, normative complexity relates to the inherent difficulty of deciding what kinds of changes are \'improvements\' or, more broadly, what is valuable in healthcare. We suggest that explanatory and normative complexity intersect and that anyone interested in healthcare improvement needs to be sensitive to both. After briefly introducing the idea of normative complexity, we consider some contrasting examples of conversations, reflecting on how they do and might contribute to healthcare quality. We discuss both conversations that are deliberately organised and facilitated (\'orchestrated conversations\') and more informally occurring and routine conversations. In the first half of the paper, we draw on some examples of orchestrated and routine conversations to open up these issues. In the second half of the paper, we bring some more theoretical lenses to bear on both conversations and normative complexity, summarise what we take to be the value of conversations and draw together some of the implications of our discussion. In summary, we argue that conversations can play a crucial role in negotiating the normative complexity of healthcare quality improvement because of their capacity to hold together a plurality of perspectives, to contribute and respond to emergence and to help underpin institutional conditions for empathy and imagination.
摘要：
在本文中,我们考虑对话在改善医疗质量方面的作用.更具体地说,我们认为，对话在回应我们所谓的“规范性复杂性”方面可能很重要。除了反思对话的价值，目的是引入规范复杂性的维度，作为需要理论和实践关注的东西，以及更公认的复杂系统的挑战，我们贴上标签，简而言之,作为“解释复杂性”。简而言之,规范的复杂性与决定哪种变化是“改进”或“改进”的固有困难有关，更广泛地说，什么是有价值的医疗保健。我们建议解释性和规范性复杂性相交，任何对医疗保健改善感兴趣的人都需要对两者敏感。在简要介绍了规范复杂性的概念之后，我们考虑一些对比鲜明的对话例子，反思他们如何做，并可能有助于医疗保健质量。我们讨论了故意组织和促进的对话（“精心安排的对话”）以及更非正式地进行和例行对话。在论文的前半部分，我们借鉴了一些精心策划和例行对话的例子来解决这些问题。在论文的后半部分，我们带来了一些更多的理论镜头来影响对话和规范的复杂性，总结我们认为对话的价值，并总结我们讨论的一些含义。总之,我们认为，对话可以在协商医疗质量改进的规范性复杂性方面发挥关键作用，因为它们有能力将多种观点结合在一起，对出现做出贡献和回应，并帮助支持同情和想象力的制度条件。
