This think tank session will engage participants in deliberations that support the development of a tool to assess the construct of “learning healthcare system” (LHS). LHS proposes that healthcare can be made safer, more efficient and higher quality through continual quality improvement and more deliberate use of patient data to promote discovery. An increasing number of healthcare organizations are embracing the idea of becoming an LHS, but are challenged by the lack of specificity surrounding the construct.
The presenters began developing an assessment tool in 2018, a process which includes a review of LHS-related literature; the identification of core elements or principles; operationalizing those elements into observable practices and organizational features; developing items and scales to measure those practices and features; refining items through pilot testing in multiple healthcare organizations; and assessing the validity and reliability of the scales. Findings from our analysis of LHS-related literature will be presented at this session. Participants will break into small groups where they will report how LHS is being defined and operationalized in their own settings, identify the elements that they regard as most important to the LHS construct, and offer suggestions for assessing the degree to which those elements are in place. Each group will have a facilitator who will take notes and report out major recommendations when the full group reconvenes. More complete notes from will be compiled and synthesized following the session and will be sent to participants along with an invitation to remain engaged in the tool-development process.
In a highly influential 2007 publication, the National Institute of Medicine (subsequently renamed the National Academy of Medicine) promoted the concept of a “learning healthcare system” (LHS) as vision for transforming the delivery of healthcare, the conduct of health research and the translation of research into practice. The original conceptualization of LHS focused on evidence-based medicine and discovery as a natural outgrowth of patient care, under the assumption that these will enhance innovation, quality, safety and value in health care. Later definitions have become more specific in terms of what occurs within an LHS: “science, informatics, incentives, and culture are aligned for continuous improvement and innovation, with best practices seamlessly embedded in the delivery process and new knowledge captured as an integral by-product of the delivery experience.”
An increasing number of healthcare systems, especially academic medical centers (AMCs), are seeking to become LHSs, in large part because of the emphasis that the National Institutes of Health has placed on LHS within the Clinical and Translational Science Awards (CTSA) program. In many ways, becoming a fully-fledged LHS has become equivalent to meeting the expectations of a CTSA grant.
However, many leaders of AMCs are unclear on precisely how their organizations need to change in order to qualify as an LHS. They know that they need to make their patient data more accessible for inquiry and research, and that employees need to engage in data analysis and research, and that more quality improvement work needs to happen throughout the organization. But there is little guidance as to how much learning, research, implementation of evidence-based practice and quality improvement projects need to be in place to quality as an LHS. How broad and deep do the changes need to go in order to actually produce the envisioned improvements in patient care and discovery?
The fact that these questions remain open more than a decade after the introduction of LHS speaks to the need for an organizational assessment tool which operationalizes the construct and measures the critical elements. Such a tool would provide direction to healthcare leaders as to where to invest their attention and resources, while also allowing a means of evaluating how much transformation occurs in response to those investments.
The Evaluation Program within Wake Forest University’s Clinical and Translational Science Institute is developing an assessment tool for the LHS construct. We conducted a systematic review of academic literature relating to the LHS construct. Relevant articles were analyzed using NVivo to identify convergent and divergent themes with regard to: the definition of LHS, principles and practices associated with an LHS, enabling conditions, and strategies to create an LHS. Findings from this analysis are being shared with institutional leaders and researchers at Wake Forest Baptist Health, as well other academic medical centers, with the intent of gaining a consensus as to which are the most important elements of an LHS and what it means to say that those elements are in place.
The think tank session at AEA provides an important opportunity to extend and expand this vetting and consensus-building process by engaging evaluators with experience in academic medicine, organizational learning, translational research, informatics and other relevant disciplines.