Using a network organisational architecture to support the development of Learning Healthcare Systems

Abstract

The US National Academy of Sciences has called for the development of a Learning Healthcare System in which patients and clinicians work together to choose care, based on best evidence, and to drive discovery as a natural outgrowth of every clinical encounter to ensure innovation, quality and value at the point of care. However, the vision of a Learning Healthcare System has remained largely aspirational. Over the last 13 years, researchers, clinicians and families, with support from our paediatric medical centre, have designed, developed and implemented a network organisational model to achieve the Learning Healthcare System vision. The network framework aligns participants around a common goal of improving health outcomes, transparency of outcome measures and a flexible and adaptive collaborative learning system. Team collaboration is promoted by using standardised processes, protocols and policies, including communication policies, data sharing, privacy protection and regulatory compliance. Learning methods include collaborative quality improvement using a modified Breakthrough Series approach and statistical process control methods. Participants observe their own results and learn from the experience of others. A common repository (a ‘commons’) is used to share resources that are created by participants. Standardised technology approaches reduce the burden of data entry, facilitate care and result in data useful for research and learning. We describe how this organisational framework has been replicated in four conditions, resulting in substantial improvements in outcomes, at scale across a variety of conditions.

Networked health care: Rethinking value creation in learning health care systems

“…Including researchers in the development of those coproduced services further opens the possibility of linking the process of discovery as a natural outgrowth of patient care. This idea underlies the concept of the Learning Health System …”

How to Conduct Clinical Trials in Children: A Tutorial

“…The success of a clinical trial not only depends on thoughtful and age‐appropriate study design but also on accessibility to appropriate research facilities to conduct the research. The “right place” for conducting pediatric research encompasses considerations that include the physical space, the professional staff, and a research infrastructure (e.g., IRB, human subjects protection program, professional research education/training) that has the wellbeing of the child at the center of its mission focus and a dedication to creating a safe and positive learning environment at the forefront of its operations . Institutions driven by a mission that embraces the core principles of safety, teamwork, compassion, and excellence create the potential for an ideal environment for developing and supporting a successful pediatric clinical trial program.…”

“…The "right place" for conducting pediatric research encompasses considerations that include the physical space, the professional staff, and a research infrastructure (e.g., IRB, human subjects protection program, professional research education/training) that has the wellbeing of the child at the center of its mission focus and a dedication to creating a safe and positive learning environment at the forefront of its operations. 49 Institutions driven by a mission that embraces the core principles of safety, teamwork, compassion, and excellence create the potential for an ideal Clinical Trials in Children Shakhnovich et al environment for developing and supporting a successful pediatric clinical trial program. Although, arguably, these core facets are also required of institutions where adult trials are conducted, it is their orientation toward the unique challenges (and opportunities) of pediatrics, encompassing care for infants, children, and adolescents, that makes them distinct.…”

Organizing for collaboration: An actor‐oriented architecture in ImproveCareNow

“…Increasing the number of actors with the values and capabilities to self‐organize entails both increasing awareness of the learning health system and one's role in it and making it easier for people to participate in and improve it. CLHS leaders build a sense of shared responsibility and commitment to the shared goal of improving outcomes . Collaboration is an important cultural norm, aimed at creating an environment of “all teach, all learn.” This captures an important part of CLHS culture: If someone has a good idea for improving outcomes, he or she would eagerly share so that others (and therefore the whole network) can benefit.…”