A framework for value-creating learning health systems

Abstract

Background Interest in value-based healthcare, generally defined as providing better care at lower cost, has grown worldwide, and learning health systems (LHSs) have been proposed as a key strategy for improving value in healthcare. LHSs are emerging around the world and aim to leverage advancements in science, technology and practice to improve health system performance at lower cost. However, there remains much uncertainty around the implementation of LHSs and the distinctive features of these systems. This paper presents a conceptual framework that has been developed in Canada to support the implementation of value-creating LHSs. Methods The framework was developed by an interdisciplinary team at the Institut national d’excellence en santé et en services sociaux (INESSS). It was informed by a scoping review of the scientific and grey literature on LHSs, regular team discussions over a 14-month period, and consultations with Canadian and international experts. Results The framework describes four elements that characterise LHSs, namely (1) core values, (2) pillars and accelerators, (3) processes and (4) outcomes. LHSs embody certain core values, including an emphasis on participatory leadership, inclusiveness, scientific rigour and person-centredness. In addition, values such as equity and solidarity should also guide LHSs and are particularly relevant in countries like Canada. LHS pillars are the infrastructure and resources supporting the LHS, whereas accelerators are those specific structures that enable more rapid learning and improvement. For LHSs to create value, such infrastructures must not only exist within the ecosystem but also be connected and aligned with the LHSs’ strategic goals. These pillars support the execution, routinisation and acceleration of learning cycles, which are the fundamental processes of LHSs. The main outcome sought by executing learning cycles is the creation of value, which we define as the striking of a more optimal balance of impacts on patient and provider experience, population health and health system costs. Conclusions Our framework illustrates how the distinctive structures, processes and outcomes of LHSs tie together with the aim of optimising health system performance and delivering greater value in health systems. Electronic supplementary material The online version of this article (10.1186/s12961-019-0477-3) contains supplementary material, which is available to authorized users.

Leadership Perspectives on Learning Health Systems: a qualitative interview study

“…Transparent and iterative, cyclical improvement processes in the LHS to enable timely access, sharing and streamlined linkage of data, with mechanisms to feedback into frontline care, were recognised as important in ensuring the LHS approach was impactful and sustainable. These ndings are commensurate with the emerging literature that describes systematic approaches and processes that are common in all LHS environments [2,9,11,[24][25][26].…”

“…Data access, systems and processes to producing useable, useful and quality data was identi ed as a theme and is generally reported in literature on the impact of LHS models [3,[8][9][10][11]. We found that appropriate infrastructure and transparent processes are reportedly needed to operationalise data access, linkage, analysis and applications.…”

“…However, only a minority (less than less than fteen percent) of healthcare organisations worldwide are adept in data-driven processes to support informed decisions at point of care, as reported in a large study involving over 700 health care leaders [7]. The Learning Health System (LHS) has been proposed as a framework for incorporating best practice and taking a systems approach [3,[8][9][10]. In a recent systematic review, it was found that a co-developed, sustainable LHS provides the necessary elements and environments to shape the healthcare systems of the future [11].…”

Leaders' Perspectives on Learning Health Systems: a qualitative study 

“…Data access, systems and processes to producing useable, useful and quality data was identi ed as a theme and is generally reported in literature on the impact of LHS models [3,[8][9][10][11]. We found that appropriate infrastructure and transparent processes are required to operationalise data access, linkage, analysis and applications.…”

Evaluating research investment and impact at a regional Australian Hospital and Health Service: a programme theory and conceptual framework

“…The elements of the programme theory are presented in a conceptual framework that identifies seven contextual factors acting as enablers or barriers to the functioning of the intended theory, some of which appeared to have the potential to hinder or even derail the health service's research impact expectations and ambitions. By identifying both impact types and contextual factors, this study and the planned research impact evaluation contribute to an identified need for empirical examination of how "learning healthcare systems", that is health systems that intertwine production and implementation of evidence with routine healthcare, are enacted in practice [24], including how they deliver "value" in clinical settings [25].…”