Leaders’ perspectives on learning health systems: a qualitative study

Abstract

Background Integrated utilisation of digital health data has the power to transform healthcare to deliver more efficient and effective services, and the learning health system (LHS) is emerging as a model to achieve this. The LHS uses routine data from service delivery and patient care to generate knowledge to continuously improve healthcare. The aim of this project was to explore key features of a successful and sustainable LHS to inform implementation in an Academic Health Science Centre context. Methods We purposively identified and conducted semi-structured qualitative interviews with leaders, experienced in supporting or developing data driven innovations in healthcare. A thematic analysis using NVivo was undertaken. Results Analysis of 26 interviews revealed five themes thought to be integral in an effective, sustainable LHS: (1) Systematic approaches and iterative, continuous learning with implementation into healthcare contributing to new best-practice care; (2) Broad stakeholder, clinician and academic engagement, with collective vision, leadership, governance and a culture of trust, transparency and co-design; (3) Skilled workforce, capability and capacity building; (4) Resources with sustained investment over time and; (5) Data access, systems and processes being integral to a sustainable LHS. Conclusions This qualitative study provides insights into the elements of a sustainable LHS across a range of leaders in data-driven healthcare improvement. Fundamentally, an LHS requires continuous learning with implementation of new evidence back into frontline care to improve outcomes. Structure, governance, trust, culture, vision and leadership were all seen as important along with a skilled workforce and sustained investment. Processes and systems to optimise access to quality data were also seen as vital in an effective, sustainable LHS. These findings will inform a co-designed framework for implementing a sustainable LHS within the Australian healthcare and Academic Health Science Centre context. It is anticipated that application of these findings will assist to embed and accelerate the use of routine health data to continuously generate new knowledge and ongoing improvement in healthcare delivery and health outcomes.

Pressure Injury Surveillance and Prevention in Australia: Monash Partners Capacity Building Framework

“…The findings from this study provided benchmark areas for the improvement in HAPI documenting and reporting. The discussed improvements in the HAPI data quality are in line with the AHRA data-driven healthcare improvement activities (52) and the Monash Partners Learning Health System approach to guide the evidence informed decisionmaking in healthcare delivery (53). The Learning Health Systems provide the necessary elements and create environments, enabling the clinicians to translate research into practise and the consumers to participate in research (54,55).…”

A Learning Health System Framework to Operationalize Health Data to Improve Quality Care: An Australian Perspective

“…National governance was established through the datadriven healthcare improvement committee, and the initial priority setting process occurred with nominated members from each competitively accredited Research Translation Centre, consumers, and stakeholder representatives (9). Detailed methods and results of the systematic review and qualitative research are published elsewhere (7,8) and summarized here.…”

“…The expert panel and systematic review had informed the questions explored in the qualitative research. We purposively identified and conducted semistructured qualitative interviews with national and international leaders, including in the UK and Canada, experienced in supporting or developing datadriven innovations in healthcare (7). Representatives from all AHRA centres, Monash Partners member organizations, the Digital Health Collaborative Research Centre, State Government, Australian Digital Health Agency, Public Health Research Network, consumers and international experts from both the UK and Canada, were interviewed.…”

“…• Systematic approaches and iterative, continuous learning with implementation into healthcare contributing to new best-practice care to improve outcomes five themes, integral to an effective, sustainable LHS, as shown in Box 2. Full details of the qualitative research are published (7).…”

“…There is a recognized vital need for systems-level change to improve healthcare using an iterative learning health system (LHS) approach (1,2). The LHS broadly encompasses the operationalization and conversion of routinely collected health data into useful information to enable informed, timely decisions to improve quality healthcare and health outcomes (2)(3)(4)(5)(6)(7)(8). Herein, we describe the coproduction process and the outcome for the development of the Monash Partners LHS framework, integrating research and data utilization into healthcare to improve outcomes.…”