What allows a health care system to become a learning health care system: Results from interviews with health system leaders

Abstract

Introduction The US health care system faces pressure to improve quality while managing complexity, curbing costs, and reducing inefficiency. These shortcomings have sparked interest in the Learning Health Care System (LHCS) as an alternate approach to organizing research and clinical care. Although diverse stakeholders have expressed support for moving toward an LHCS model, limited guidance exists for institutions considering such a transition. Methods Interviews were conducted with institutional leaders from 25 health care systems considered to be at the forefront of LHCS. Interviews focused on the process of transitioning toward an LHCS, including motivations for change, key components, challenges encountered, and strategies for success, and on ethics and regulatory issues encountered. Qualitative analysis identified key themes across institutions. Results Respondents described 5 themes related to the origin of their LHCS transformation: (1) visionary leadership or influence of a key individual, (2) adaptation to a changing health care landscape, (3) external funding, (4) regulatory or legislative influence, and (5) mergers or expansions. They described 6 challenges: (1) organizational culture, (2) data systems and data sharing, (3) funding learning activities, (4) limited supply of skilled individuals, (5) managing competing priorities, and (6) regulatory challenges. Finally, they suggested 8 strategies to support transformation: (1) strong leadership, (2) setting a limited number of organizational priorities, (3) building on existing strengths, (4) training programs, (5) “purposeful” design of data systems, (6) internal transparency of quality metrics, (7) payer/provider integration, and, within academic medical centers, (8) academic/clinical integration. Conclusions Even institutions at the forefront of LHCS described the transition as difficult. Their experiences provide insight into other institutions considering similar transitions, including elements essential for success and likely challenges.

Development of Enriched Core Competencies for Health Services and Policy Research

“…This creates a growing need for researchers with a wider array of skills like leadership, communication, and management (Tamblyn ; Reid ; Forrest et al. ) as well as for health care leaders with a commitment to evidence‐informed continuous improvement (Morain, Kass, and Grossmann ). Well‐prepared PhD graduates can make important contributions to health policy and system transformation, whether as embedded researchers or as health system leaders.…”

“…In addition, the concept of the learning health system is spreading, and health care organizations are working to harness the power of data, decision sciences, and patient engagement to drive continuous improvement. This creates a growing need for researchers with a wider array of skills like leadership, communication, and management (Tamblyn 2014;Reid 2016;Forrest et al 2018) as well as for health care leaders with a commitment to evidence-informed continuous improvement (Morain, Kass, and Grossmann 2017). Well-prepared PhD graduates can make important contributions to health policy and system transformation, whether as embedded researchers or as health system leaders.…”

Stakeholder perspectives regarding alternate approaches to informed consent for comparative effectiveness research

“…CER/PCOR studies are often embedded in usual care settings, designed both to produce results that reflect real‐world care environments, and to facilitate recruitment of the larger cohorts needed for comparing non‐investigational treatments . This research is consistent with a broader interest in moving towards a learning health system (LHS), involving a bidirectional feedback loop whereby data collection is embedded into care delivery processes, and this evidence is used to improve care …”

“…towards a learning health system (LHS), involving a bidirectional feedback loop whereby data collection is embedded into care delivery processes, and this evidence is used to improve care. 2 These features of CER/PCOR studies have prompted questions regarding the appropriateness of traditional informed consent mechanisms. Requirements for informed consent for research in the United States have a deep and important history, with regulations requiring consent for most studies having been promulgated after a series of unconscionable examples of research conducted without consent were brought to the attention of the American public.…”

The science of Learning Health Systems: Foundations for a new journal

“…Research Reports describe original data‐driven investigations to design or model, formulate or develop, enable or facilitate, implement, assess, or evaluate LHSs. This issue includes two research reports: an article by Richard Tannen and colleagues introducing statistical methods for drawing potentially causal conclusions from observational data; and an article by Stephanie Morain and colleagues that draws insights from interview data on how health systems transition to learning systems …”