Organizational Learning in an Integrated Health System: Informing Operations for a Learning Health Care System

Clarke, Deserae; Gerrity, Gloria; Stametz, Rebecca; Young, Amanda; Davis, Daniel E.

doi:10.17294/2330-0698.1587

Cited by 2 publications

(4 citation statements)

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“…Prior research with Geisinger employees sought to determine support and preparedness for establishing Geisinger as a “learning heath system” (4), in which research is seamlessly embedded into practice to enable continuous learning and improvement. A survey found that 98% ( n = 126) of respondents (most of whom were clinicians) agreed that “evidence supports the claim that a learning health system is necessary to provide safe, effective, and beneficial patient-centered care at lower cost,” with 53% of the sample strongly agreeing with this statement (22). Interviews ( n = 41) with Geisinger leadership similarly found unanimous support for “the general concept and goals” of the learning healthcare system and for “enhancing learning across the institution” (23).…”

Section: Resultsmentioning

confidence: 99%

Objecting to experiments that compare two unobjectionable policies or treatments

Meyer

Heck

Holtzman

et al. 2019

Proc. Natl. Acad. Sci. U.S.A.

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Randomized experiments have enormous potential to improve human welfare in many domains, including healthcare, education, finance, and public policy. However, such “A/B tests” are often criticized on ethical grounds even as similar, untested interventions are implemented without objection. We find robust evidence across 16 studies of 5,873 participants from three diverse populations spanning nine domains—from healthcare to autonomous vehicle design to poverty reduction—that people frequently rate A/B tests designed to establish the comparative effectiveness of two policies or treatments as inappropriate even when universally implementing either A or B, untested, is seen as appropriate. This “A/B effect” is as strong among those with higher educational attainment and science literacy and among relevant professionals. It persists even when there is no reason to prefer A to B and even when recipients are treated unequally and randomly in all conditions (A, B, and A/B). Several remaining explanations for the effect—a belief that consent is required to impose a policy on half of a population but not on the entire population; an aversion to controlled but not to uncontrolled experiments; and a proxy form of the illusion of knowledge (according to which randomized evaluations are unnecessary because experts already do or should know “what works”)—appear to contribute to the effect, but none dominates or fully accounts for it. We conclude that rigorously evaluating policies or treatments via pragmatic randomized trials may provoke greater objection than simply implementing those same policies or treatments untested.

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Section: Resultsmentioning

confidence: 99%

Objecting to experiments that compare two unobjectionable policies or treatments

Meyer

Heck

Holtzman

et al. 2019

Proc. Natl. Acad. Sci. U.S.A.

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“… Real-time access to and analysis of data [ 17 , 20 , 40 , 70 ]. Need to access data without the assistance of a data analyst [ 21 ]. Use of LHS tools / dashboards with minimal or no training (i.e.…”

Section: Resultsmentioning

confidence: 99%

“… Organizational factors Uncertainty of financial sustainability [ 18 , 22 ] Internal drivers and resources within the organization, rather than depending on external funding [ 13 , 53 , 57 , 73 ]. Increasing awareness of LHS and developing a culture of learning and improving throughout organization [ 21 ]. Broad adoption of programs across leadership and providers [ 24 , 35 ].…”

Section: Resultsmentioning

confidence: 99%

“…Training highly qualified personnel and educating healthcare providers to support a sustainable culture for learning and encouraging participation in learning / quality improvement activities [ 16 , 17 , 34 , 40 ]. Need to involve patients and community [ 20 , 21 , 31 , 34 ]. Initiatives to increase patient and family involvement, including the development of patient and family advisory councils, or allowing patients to access their data through secure patient portals [ 20 ].…”

Section: Resultsmentioning

confidence: 99%

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Learning health systems in primary care: a systematic scoping review

et al. 2021

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Background Learning health systems have been gaining traction over the past decade. The purpose of this study was to understand the spread of learning health systems in primary care, including where they have been implemented, how they are operating, and potential challenges and solutions. Methods We completed a scoping review by systematically searching OVID Medline®, Embase®, IEEE Xplore®, and reviewing specific journals from 2007 to 2020. We also completed a Google search to identify gray literature. Results We reviewed 1924 articles through our database search and 51 articles from other sources, from which we identified 21 unique learning health systems based on 62 data sources. Only one of these learning health systems was implemented exclusively in a primary care setting, where all others were integrated health systems or networks that also included other care settings. Eighteen of the 21 were in the United States. Examples of how these learning health systems were being used included real-time clinical surveillance, quality improvement initiatives, pragmatic trials at the point of care, and decision support. Many challenges and potential solutions were identified regarding data, sustainability, promoting a learning culture, prioritization processes, involvement of community, and balancing quality improvement versus research. Conclusions We identified 21 learning health systems, which all appear at an early stage of development, and only one was primary care only. We summarized and provided examples of integrated health systems and data networks that can be considered early models in the growing global movement to advance learning health systems in primary care.

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Organizational Learning in an Integrated Health System: Informing Operations for a Learning Health Care System

Cited by 2 publications

References 0 publications

Objecting to experiments that compare two unobjectionable policies or treatments

Objecting to experiments that compare two unobjectionable policies or treatments

Learning health systems in primary care: a systematic scoping review

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