Organizing for collaboration: An actor‐oriented architecture in ImproveCareNow

Abstract

Background: Collaborative learning health systems (CLHSs) enable patients, clinicians, researchers, and others to collaborate at scale to improve outcomes and generate new knowledge. An organizational framework to facilitate this collaboration is the actor-oriented architecture, composed of (a) actors (people, organizations, and databases) with the values and abilities to self-organize; (b) a commons where they create and share resources; and (c) structures, protocols, and processes that facilitate multiactor collaboration. CLHSs may implement a variety of changes to strengthen the actor-oriented architecture and enable more actors to create and share resources.Objective: To describe and measure implementation of elements of the actororiented architecture in an existing Collaborative Learning Health System. Methods:We used the case of ImproveCareNow, a CLHS improving outcomes in pediatric inflammatory bowel disease, founded in 2006. We traced several networklevel indicators of actor-oriented architecture between 2010 and 2016. Results:We identified measures of actors, the commons, and ways that have made it easier for network member sites to participate. These indicators show ImproveCareNow has made changes in the three elements of the actor-oriented architecture over time. Conclusion:It is possible to measure the implementation of an actor-oriented architecture in a CLHS. The elements of the actor-oriented architecture may provide a conceptual framework for their development and optimization. Metrics such as those described here may be actionable indicators of the "health of the system." K E Y W O R D Schronic care, collaborative learning health systems, organizational theory

Measuring engagement in a collaborative learning health system: The case ofImproveCareNow

“…23 In building this system, we adapted an approach used in political community organizing, which, like ICN, often relies on volunteers becoming progressively engaged in campaign activities. 15,24 In addition to the capabilities and uses highlighted above, the approach may be especially powerful when data are combined with data from other network resources. estimate the resources spent on devising the approach described in this report.…”

“…In a CLHS, engagement refers to the degree to which people (patients and families, clinicians, researchers, and others) are involved in creating and sharing information, knowledge, and knowhow to improve health and healthcare. [12][13][14][15] For example, in one CLHS (ImproveCareNow, described below), a group of highly engaged young people with inflammatory bowel disease (IBD) worked together to create a digital product describing experiences of patients who had undergone an ostomy. 16 The rationale for doing so included that they had "experienced a lack of psychosocial education about our surgeries.…”

A collaborative learning health system agent‐based model: Computational and face validity

“…7 It is thought that CLHSs achieve collaboration at scale by implementing the AOA 24 and we have shown previously that one CLHS has executed interventions consistent with the AOA. 25 Predicated on the idea that outcomes for a given population are maximized by matching each individual patient to the best treatment (s), 26,27 we assert that well-functioning CLHSs improve the patienttreatment matching process and its implementation. Our ABM is designed to investigate this matching process at the level of the clinical encounter and how a CLHS can facilitate this matching process.…”

Putting the network to work: Learning networks in rapid response situations

“…Existing research on Learning Networks, one form of LHS, emphasizes the role of people and community—in addition to other elements of infrastructure—in doing the work of the LHS. Past work has emphasized that Learning Networks have an actor‐oriented architecture, which “consists of actors (people and institutions) with the values and capabilities to self‐organize; a commons where they create and share resources; and structures, protocols, and processes that make it easy to form highly functional teams” (Seid et al, 9 p. 2). There is also a shared infrastructure across networks that can be customized to individual networks' needs 9 .…”

“…Past work has emphasized that Learning Networks have an actor‐oriented architecture, which “consists of actors (people and institutions) with the values and capabilities to self‐organize; a commons where they create and share resources; and structures, protocols, and processes that make it easy to form highly functional teams” (Seid et al, 9 p. 2). There is also a shared infrastructure across networks that can be customized to individual networks' needs 9 . Thus, there are some standardized elements of infrastructure, but also a recognition that infrastructure needs to be adapted for the particular needs of a given network.…”