You gave the provocative title, 'Thinking out of the box' (feature, pages 32-33, 12 April), to an article which unfortunately seems to have mislabelled the boxes described, and which could lead to confusion and misinterpretation as a result.

First, the authors interpret managing demand as a new form of rationing, which will be counterproductive and is a misinterpretation of this new and far more complex agenda, as I have suggested elsewhere.

1What the authors then go on to describe as systems thinking is a linear checklist approach, which we know is very popular - particularly with doctors - at present, but is an oversimplification of managerial realities, as Peter Checkland knows from 30 years in this field.

However, they then go on to include Stacey's work as an exemplar of this approach; as the key UK management academic in complexity theory, he is in reality the counter to the systems approach, as suggested in his book, Complexity and Management - fad or radical challenge to systems thinking? published by Routeledge last year.

If we are going to get out of these boxes, we need to know which ones we are in to start with.

Annabelle Mark Reader in organisational behaviour and health Management Middlesex University Business School


1 Mark A, Pencheon D, Elliott R. Demanding healthcare. International J of Health Planning & Management (15) 237-253.

2 Checkland P. Systems Thinking, Systems Practice. J Wiley 1999.