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J R Soc Med. 2002 April; 95(4): 220.
PMCID: PMC1279534

Self-regulation in hospital waiting lists

In their response to the paper by Papadopoulos and colleagues1, Dr Freckleton and Professor Sutherland2 unwittingly illustrate the drawbacks of hypothesis-testing for exploring complex phenomena. Their null hypothesis, presumably, is that no useful management or order is in place—conjuring up images of managers, like Keystone Cops, running around banging into one another and achieving nothing. We should not be surprised if they are able to refute this. By contrast, our Bayesian approach allows exploration of emerging patterns within such systems3. Freckleton and Sutherland's analysis of waiting lists, in their table, has shown true subtle effects but tells us little about the underlying complexity.


1. Papadopoulos M, Hadjitheodossiou M, Chrysostomou C, Hardwidge C, Bell BA. Is the National Health Service at the edge of chaos? J R Soc Med 2001;94: 613-16 [PMC free article] [PubMed]
2. Freckleton RP, Sutherland WJ. Do in-hospital waiting lists show self-regulation? J R Soc Med 2002;95: 164. [PMC free article] [PubMed]
3. Smethurst DP, Williams HC. Power laws. Are hospital waiting lists self-regulating? Nature 2001;410: 852-3 [PubMed]

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