Evaluating Health Organization Readiness for Implementing a Learning Health System: Literature Review to Inform Questionnaire Development

Abstract

Objective: Adopting a learning health system (LHS) is a promising approach to bridging knowledge-to-practice gaps. The aim of this study was to explore how LHS are defined and characterized in the literature, the barriers and facilitators health organizations may face when implementing an LHS, and what tools currently exist to help health organizations assess their readiness to implement an LHS. Methods: A literature review was conducted to identify items relevant for developing the content of an LHS readiness questionnaire. PubMed and the Learning Health Systems journal were searched from inception to December 2023. Publications that addressed the definitions, frameworks, characteristics, barriers, and facilitators of an LHS were included. Results: Of the 28 included articles, 16 provided a definition of LHS–eight of which were based on the Institute of Medicine’s definition (i.e., where science, informatics, incentives, and culture are aligned for continuous improvement and innovation). 16 articles provided domains associated with an LHS framework that informed our questionnaire. These included data to knowledge, knowledge to practice, practice to data, and core values. Barriers to adopting an LHS approach included financial constraints, time, and the complexity of the task; facilitators included financial incentives, government mandates, and consistent implementation across centres. Conclusion: Few specific LHS readiness tools have been outlined in the extant literature. Current readiness tools derived from quality improvement contexts may be helpful but not sufficiently specific for assessing healthcare organizations’ readiness to implement an LHS. A new LHS readiness questionnaire may help meet this need, but further refinement and validation is required.