{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T19:58:23Z","timestamp":1790452703906,"version":"4.1.0"},"reference-count":38,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T00:00:00Z","timestamp":1790380800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T00:00:00Z","timestamp":1790380800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Planning &amp;amp; Management"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Although a complexity theory lens can help to understand national policy implementation at a local government level, application of this lens often remains at a metaphorical level. We illustrate how complexity concepts, such as adaptation, feedback, emergence and co\u2010evolution can be used practically in research on policy implementation using a UK case study (Future in Mind; FiM), aimed at improving school children's access to mental health services in a metropolitan borough in the North England.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We re\u2010analysed interview data with staff from local government, National Health Service\/mental health, schools, and the voluntary and community sector (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a031 semi\u2010structured interviews) involved in the implementation of FiM and coded this data in NVivo12 using complexity concepts as sensitising constructs.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>We identified 5 feedback loops: two positives (1.\u00a0Flexing the training offer; 2. New skills, knowledge and behaviour by non\u2010specialist staff) and three negatives (3.\u00a0Short termism, 4. Free rider behaviour, 5. Professional boundaries). These loops energised local adaptations of FiM by school and NHS staff, leading to system\u2010level change (emergence), with the school system becoming more responsive to mental wellbeing needs of children and young people, and shifts across systems (co\u2010evolution), by developing joint values and language between schools and NHS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We demonstrate the importance of positive and negative feedback loops for evidencing system\u2010level change and shifts across systems. Our findings provide new insights into unintended consequences of policy implementation and starting positions for implementers to utilise feedback for generating impact. We argue for a blurring of boundaries between implementation and evaluation in policy research to optimise the use of feedback.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hpm.70140","type":"journal-article","created":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T19:20:55Z","timestamp":1790450455000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Applying a Complexity Lens to Policy Implementation: How Feedback Loops Help to Understand Systems Change in Integrated Healthcare"],"prefix":"10.1002","author":[{"given":"Andrew","family":"Passey","sequence":"first","affiliation":[{"name":"School of Health Leeds Beckett University  Leeds UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2466-2792","authenticated-orcid":false,"given":"Peter","family":"van der Graaf","sequence":"additional","affiliation":[{"name":"Department of Nursing Midwifery and Health Northumbria University  Newcastle\u2010upon\u2010Tyne UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,26]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/hpm.3830"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1080\/09540962.2022.2117894"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1080\/14719037.2019.1708435"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1080\/14719037.2017.1364406"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1080\/14719037.2017.1364414"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/hpm.3741"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1478\u20109302.2012.00270.x"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.evalprogplan.2014.04.002"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.20377\/cgn\u201056"},{"key":"e_1_2_10_11_1","first-page":"159","volume-title":"Systems and Complexity\u2010Informed Evaluation: Insights from Practice. 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