If still unresolved perhaps a change of environment is needed, although staff may not wholly agree. Although the patient may not be able to request a move to more appropriate accommodation others must do so if needed, rather than a resort to a so-called 'chemical fix'. Integrated care pathways anticipate change, charting the planned progression through a care episode which can then be audited. Epidemiological changes in the population must be dealt with politically. Definitions of 'family' have changed in the west, and are under pressure in other spheres.
Social change occurs in obvious and subtle ways, at the level of population and family units.
Recognition of change is a key determinant in family and interpersonal therapies and interventions. The examples above highlight once more the multicontextual nature of health, few problems are exclusively the province of a single quadrant.