Despite a recognition that health service research has failed to make its full contribution to health service improvement, the fact that evidence is not widely accommodated into practice is seen as a failure of communication rather than the inappropriate application of a particular form of investigation. Dominant theoretical frameworks still retain the fundamental idea that order needs to be somehow created by external forces and that organizational issues will inevitably yield to more collection of data and the application of increasingly sophisticated analytical techniques. This paper explores alternative perspectives and methodological opportunities that arise from viewing health service as a complex non-linear system. This approach may offer new research insights that more accurately reflect underlying mechanisms and may help to explain the limitations of current analytical techniques.