Clarifying the concept of a learning health system for healthcare delivery organizations: Implications from a qualitative analysis of the scientific literature

Abstract

The "learning health system" (LHS) concept has been defined in broad terms, which makes it challenging for health system leaders to determine exactly what is required to transform their organization into an LHS. This study provides a conceptual map of the LHS landscape by identifying the activities, principles, tools, and conditions that LHS researchers have associated with the concept. Through a multi-step screening process, two researchers identified 79 publications from PubMed (published before January 2020) that contained information relevant to the question, "What work is required of a healthcare organization that is operating as an LHS?" Those publications were coded as to whether or not they referenced each of 94 LHS elements in the taxonomy developed by the study team. This taxonomy, named the Learning Health Systems Consolidated Framework (LHS-CF), organizes the elements into five "bodies of work" (organizational learning, translation of evidence into practice, building knowledge, analyzing clinical data, and engaging stakeholders) and four "enabling conditions" (workforce skilled for LHS work, data systems and informatics technology in place, organization invests resources in LHS work, and supportive organizational culture). We report the frequency that each of the 94 elements was referenced across the 79 publications. The four most referenced elements were: "organization builds knowledge or evidence," "quality improvement practices are standard practice," "patients and family members are actively engaged," and "organizational culture emphasizes and supports learning." By dissecting the LHS construct into its component elements, the LHS-CF taxonomy can serve as a useful tool for LHS researchers and practitioners in defining the aspects of LHS they are addressing. By assessing how often each element is referenced in the literature, the study provides guidance to health system leaders as to how their organization needs to evolve in order to become an LHS -while also recognizing that each organization should emphasize elements that are most aligned with their mission and goals.

Parity of esteem and systems thinking: a theory informed qualitative inductive thematic analysis

“…The concept of a learning health system (LHS), in which an organisation builds knowledge or evidence, embeds quality improvement practices as standard practice, actively engages patients and family members and supports further learning [48], offers a potentially fruitful approach to building parity across the multiple interacting domains and levels of healthcare. Taking these four elements of the learning healthcare system and using them in a PoE focused systems-based approach may offer important traction.…”

Parity of Esteem and Systems Thinking. A Theory Informed Qualitative Synthesis

“…The concept of a learning health system (LHS), in which an organisation builds knowledge or evidence, embeds quality improvement practices as standard practice, actively engages patients and family members and supports further learning 30 , offers a potentially fruitful approach to building parity across multiple interacting domains and levels of healthcare. Taking these four elements of the learning healthcare system and using them in a PoE focused systems-based approach may offer important traction.…”

Developing learning health systems in the UK: Priorities for action

“…There is also a wide range of models of LHSs, making it difficult for individuals, organisations and systems to decide on the best approach. 143 Importantly, many of the issues discussed above highlight how successful learning communities -and successful LHSs -require effective leadership. In particular, effective leadership is a critical facilitator for:…”