Learning Health Systems: Continuing The Conversation
Imagine a hospital where safety data are tracked and areas needing improvement are prioritized based on potential adverse effects on patients. In this hospital, teams are engaged in improvement activities and individual scorecards in each unit track progress. Structural issues are identified, and any barriers to solutions are overcome with escalation to senior leadership as necessary. Overall improvements in safety are celebrated widely.
This scenario describes a learning heath system in action.
Now consider on a scale from 1 to 10, where 10 is a delivery organization that continuously learns from data at all levels of the organization, and 1 is an organization that isn’t learning proactively, where would you gauge your organization to be? What would be your goal?
Over the past several months, we have been speaking with leaders from health systems across the country—from California to New York; from North Carolina to Utah—to continue our conversation on how learning health systems provide high-quality, safe, and efficient health care to their patients, and how they are safe and satisfying places to work. As part of the discussion, we have been focusing on how these systems made the business decision to invest in becoming a learning health system. To gain this perspective, we have been speaking with chief executive officers, chief financial officers, innovation officers, and clinical department leaders.
This listening tour is directly inspired by what we heard from stakeholders at our September AHRQ Research Summit on Learning Health Systems. Our stakeholders prioritized the need to develop and promote a strong business case for the learning health system. They had many other suggestions, which are available on the research summit web page on our site.
What’s clear is that our nation’s healthcare landscape remains in flux. We have entered a new digital age and there is growing emphasis on moving from volume to value. In order to succeed in this environment, health systems will need to adapt. We heard from health system leaders that being a learning health system provides a way to survive and thrive in this new environment.
Becoming a learning health system, however, requires a fundamental shift in thinking. Dr. Gary Rosenthal, Chair of the Department of Internal Medicine at Wake Forest, highlighted for us the daunting challenge in doing so, saying “to become a learning health system today requires the same cultural transformation that occurred in patient safety 20 years ago.”
Emerging from our discussions is a core set of elements that are essential for becoming a learning health system:
- Data Infrastructure. Having an electronic health record (EHR) and access to clinical data is not sufficient. The infrastructure for learning needs to bring together data from operations, payment, and patient experience. This combined data can be turned into knowledge to power sustainable improvement.
- Workforce. Transforming data into insights requires a core group of team members with advanced skills in interpreting data and delivery system implementation. These experts can serve as consultants across the entire health system. In order to be effective, however, they must have partners within clinical units who are prepared to partner with them. These local, front-line champions also need to have skills in data interpretation, quality improvement, and change management, as well as dedicated time to lead learning and improvement activities.
- Culture. Almost uniformly, the leaders we spoke with were emphatic that health system leaders must support and prioritize learning and nurture a culture of learning throughout the system. This cultural shift is what transforms traditional quality improvement activities into a sustainable and operational way of providing care. This theme was elegantly shared with us by Dr. Peter Pronovost at our Summit.
In all these conversations, we wanted to learn how AHRQ can add value in promoting learning health systems. AHRQ recently announced a new career development program, in partnership with the Patient-Centered Outcomes Research Institute, to build the critical and sustainable learning health system research workforce. The program will train researchers who are embedded within a health system to produce novel insights and evidence that can be rapidly implemented to improve health system performance. We are looking forward to making the initial training awards this summer.
Based on what we are hearing during our listening tour, we are planning to produce case studies to showcase how health systems are successfully implementing learning. In our conversations, we heard powerful examples of how health systems are utilizing data today to improve care tomorrow. Our hope is to develop and disseminate a small number of case studies and an overarching business case for becoming a learning health system to assist organizations on their journey to becoming a learning health system.
Do you have examples of programs or initiatives from your organization that showcase aspects of your data infrastructure, workforce, or culture that help to advance learning? If you think your story can benefit others trying to become a learning health system, we encourage you to submit your concepts to LearningHealthSystem@ahrq.hhs.gov. Here at AHRQ, we continue to listen and learn.
Gopal Khanna is Director of AHRQ and Dr. Meyers is Chief Medical Officer.
Page originally created March 2018