Analytical capacities at the heart of learning health systems: Conceptual framework based on a developmental literature review.

BackgroundIntegrated utilisation of digital health data has the power to transform healthcare to deliver more efficient and effective services, and the learning health system (LHS) is emerging as a model to achieve this. The LHS uses routine data from service delivery and patient care to generate knowledge to continuously improve healthcare. The aim of this project was to explore key features of a successful and sustainable LHS to inform implementation in an Academic Health Science Centre context.MethodsWe purposively identified and conducted semi-structured qualitative interviews with leaders, experienced in supporting or developing data driven innovations in healthcare. A thematic analysis using NVivo was undertaken.ResultsAnalysis of 26 interviews revealed five themes thought to be integral in an effective, sustainable LHS: (1) Systematic approaches and iterative, continuous learning with implementation into healthcare contributing to new best-practice care; (2) Broad stakeholder, clinician and academic engagement, with collective vision, leadership, governance and a culture of trust, transparency and co-design; (3) Skilled workforce, capability and capacity building; (4) Resources with sustained investment over time and; (5) Data access, systems and processes being integral to a sustainable LHS.ConclusionsThis qualitative study provides insights into the elements of a sustainable LHS across a range of leaders in data-driven healthcare improvement. Fundamentally, an LHS requires continuous learning with implementation of new evidence back into frontline care to improve outcomes. Structure, governance, trust, culture, vision and leadership were all seen as important along with a skilled workforce and sustained investment. Processes and systems to optimise access to quality data were also seen as vital in an effective, sustainable LHS. These findings will inform a co-designed framework for implementing a sustainable LHS within the Australian healthcare and Academic Health Science Centre context. It is anticipated that application of these findings will assist to embed and accelerate the use of routine health data to continuously generate new knowledge and ongoing improvement in healthcare delivery and health outcomes.

Learning health systems (LHS) use digital health and care data to improve care, shorten the timeframe of improvement projects, and ensure these are based on real‐world data. In the United Kingdom, policymakers are depending on digital innovation, driven by better use of data about current health service performance, to enable service transformation and a more sustainable health system.This paper examines what would be needed to develop LHS in the United Kingdom, considering national policy implications and actions, which local organisations and health systems could take.The paper draws on a seminar attended by academics, policymakers, and practitioners, a brief literature review, and feedback from policy experts and National Health Service (NHS) stakeholders.Although there are examples of some aspects of LHS in the UK NHS, it is hard to find examples where there is a continuous cycle of improvement driven by information and where analysis of data and implementing improvements is part of usual ways of working.The seminar and literature identified a number of barriers. Incentives and capacity to develop LHS are limited, and requires a shift in analytic capacity from regulation and performance, to quality improvement and transformation. The balance in priority given to research compared with implementation also needs to change.Policy initiatives are underway which address some barriers, including building analytical capacity, developing infrastructure, and data standards. The NHS and research partners are investing in infrastructure which could support LHS, although clinical buy in is needed to bring about improvement or address operational challenges.We identify a number of opportunities for local NHS organisations and systems to make better use of health data, and for ways that national policy could promote the collaboration and greater use of analytics which underpin the LHS concept.

Background. Effective and efficient sharing of knowledge in health care can lead to the clarification of health data and dissemination of up-to-date health information among employees, decision-makers, and other stakeholders, thereby improving the probability of occurrence of desirable health outcomes. The current study aimed to identify the determinants of effective knowledge management and sharing in healthcare. Methods. This study was conducted to identify the facilitators and barriers of knowledge sharing in healthcare and also identify successful strategies in this field using the approach of review studies in 2023. A thorough literature review was conducted using relevant keywords in PubMed, Scopus, and SID databases and the Google Scholar search engine. Data extraction was done by two researchers using the data extraction table. The content analysis method was used to analyze the data. Results. Reviewing 21 studies revealed 176 determinants of knowledge management and sharing in healthcare organizations. Among the determining factors, 96 were facilitators, and 80 were barriers to knowledge sharing. After removing duplicate factors and merging similar cases, 54 facilitators and 55 barriers were obtained uniquely. The determining factors were classified into four categories: organizational factors, infrastructure factors, individual factors, and factors related to the information system. Also, 35 effective strategies for knowledge management in healthcare organizations were identified, the most important of which was related to the empowerment of managers in information technology (IT). Conclusion. The success of knowledge sharing in healthcare requires a strong IT infrastructure, supportive leadership, an organizational culture that governs knowledge development, commitment and cooperation among healthcare team members, and effective knowledge management.

Objective. To study the opinion of the managers of healthcare organizations (HOs) of the Gomel region on the specifics of the functioning of outpatient and inpatient HOs in the region in the context of the third wave of COVID-19 spread, the impact of the current situation on the delivery of health care to the population.Materials and methods. A survey of 96 managers of outpatient and inpatient HOs was conducted, the features of the work in the context of an increased COVID-19 incidence rate and associated difficulties were identified.Results. The vast majority of the surveyed managers of outpatient HOs (77.3%) are convinced that the professional qualifications of medical personnel in their institutions fully meet the requirements for the work with COVID-19 patients, while this belief is shared by less than half (46.7%) of the managers of inpatient ones. However, with such a high assessment of the staffing, the managers of outpatient HOs are experiencing a real shortage of personnel: only 10.6% of them responded that they had not experienced difficulties with staffing during their work in the conditions of the COVID-19 pandemic, and 56.7% of the managers of inpatient HOs responded the same. This is probably why outpatient health care tier managers one and a half times more often noted a significant increase in the duration and intensity of the work of medical personnel during the pandemic than their colleagues from inpatient institutions (62.1 and 40%, respectively). But the opinion about the moral and psychological climate in teams practically coincides in both groups of the managers: deterioration in outpatient HOs was noted in 47% of cases, stability in inpatient ones - in 53.3% of cases. Also, in both the groups, the managers of HOs were satisfied with the normative documentation regulating the delivery of health care in the conditions of the COVID-19 pandemic (managers of outpatient HOs - 7.63 ± 1.35 points, managers of outpatient ones - 7.18 ± 1.92 out of maximum 10 points).Conclusion. The fight against the coronavirus has become a serious test for the healthcare system of the Republic of Belarus. The performed survey has revealed problematic issues that arose in the course of the professional activities of the managers of inpatient and outpatient HOs. According to the respondents, during the COVID-19 pandemic, there was a significant increase in the duration and intensity of work. There were also difficulties related to carrying out the diagnostics, shortcomings in the interaction of medical personnel, etc.

Drawing on the expertise of decision-making professionals, leaders, and managers in health care organizations, Hospitals & Health Care Organizations: Management Strategies, Operational Techniques, Tools, Templates, and Case Studies addresses decreasing revenues, increasing costs, and growing consumer expectations in today‘s increasingly competi

Perioperative Medicine: What the Future Can Hold for Anesthesiology.

The learning health system (LHS) concept represents a bold innovation that combines organizational learning, strategic analysis of patient data, stakeholder engagement and the systematic translation of research into practice - all in service of improving the quality of health care delivered across the organization. This innovation has been diffused and widely adopted by healthcare organizations over the past 15 years, but academic health centers (AHCs) have been slower on the uptake. The irony is that AHCs have the resources (e.g., trained researchers, sophisticated clinical data systems, informatics infrastructure) that are necessary to do the highest-quality and most impactful LHS work. Based on a review of publications describing how AHCs have implemented LHS work, as well as the authors' direct experience promoting the adoption of the LHS paradigm at Atrium Health Wake Forest Baptist (AHWFB), we:identify a set of factors that have inhibited broader adoption of the LHS paradigm among AHCs; distinguish between the forms of LHS work that are consistent and inconsistent with the mission of AHCs; and offer recommendations for broader adoption and fuller implementation of the LHS paradigm. The LHS paradigm represents an expansion of the scientific paradigm which serves as the foundation of research enterprise within AHCs. Both paradigms value rigorous studies of new treatments and practices, including pragmatic clinical trials. The LHS paradigm also places a high value on quality improvement studies, organizational learning, and the translation of research findings into improved patient care and operations within the local health system. The two paradigms differ on the origin of the research question, i.e., a pressing patient-care issue facing the health system versus the investigator's own research interests. Academic researchers have been disincentivized from pursuing at least some forms of LHS research. However, a growing number of AHCs are finding ways to integrate the LHS paradigm into their research enterprise, either by providing research faculty with institutional funding to cover their effort on studies that address the health system's priority issues, or by establishing an institute dedicated to LHS research. The LHS paradigm is a disruptive intervention for AHCs, one that was initially resisted but is increasingly being embraced. AHCs are developing strategies for conducting LHS research, typically in parallel to the more traditional biomedical science that is core to academic medicine. Full implementation of the LHS paradigm will require further alignment between LHS and science, including a shift in the criteria for promotion and tenure to support those researchers who choose to focus on the pressing issues facing the health system.

Lean management in health care organizations attempts to empower staff to generate continuous improvement through incremental but regular improvements in work processes. However, because of the increasing pressure on health care organizations to substantially improve quality of care and patient outcomes while containing costs in the relatively short term, many health care leaders are looking for ways to achieve large breakthrough improvements in their organization's performance. The objective of this research is to understand whether and how Lean management can be used to achieve breakthrough improvements in performance. This study used grounded theory and content analysis of in-depth, semistructured interviews with 10 nationally recognized experts in the use of Lean management in health care organizations. The 10 participants constitute a purposive sample of experts with in-depth understanding of the strengths and limitations of Lean management in health care organizations. Two out of 10 participants defined breakthrough improvement as a major change in a performance metric; 2 participants defined it as a fundamental redesign in a process or service; the remaining 6 participants defined breakthrough improvement as having both these characteristics. The extent to which participants believed Lean was an effective means for achieving breakthrough improvement in performance was related to how they defined breakthrough improvement. The 2 participants who defined breakthrough improvement as a significant change in a performance metric believed Lean methods alone were sufficient. The 2 participants who defined breakthrough improvement to be a fundamental redesign tended not to view Lean alone as an effective approach. Rather, they, and the 6 participants who defined breakthrough improvement as having both change-in-metric and process redesign characteristics, viewed human-centered design thinking as the primary or important complementary approach to achieving breakthrough improvement. Participants identified resources, culture change, and leadership commitment beyond what would be required to achieve incremental improvement as the main facilitators and barriers to achieving breakthrough improvements. This research reveals some differences in experts' definitions of breakthrough improvement, and illuminates the value of human-centered design thinking, alone or as a complement to Lean management, in achieving breakthrough improvement in health care organizations. Most of our expert participants agreed that supplementing Lean management methods with the contributions of innovation design and investing significant resources, strengthening the organizational culture to support the necessary changes, and providing stronger leadership commitment to the effort are important facilitators for achieving breakthroughs in organizational performance.

Medical knowledge management and care process management have become to be considered as valuable strategic assets that can lead to sustained increase in Health Care Organization (HCO) performance. Thus, it is essential to investigate which are the enablers for promoting knowledge-based organizations (people, organization, process, and system perspectives). Although they are essential for a HCO to manage knowledge effectively, it is still unclear how to employ them in more principled fashion. This requires innovative management strategies to determine effective ways of utilizing knowledge resources and capabilities available both within and outside the organization. This paper reviews knowledge and process management theories, methods, and technologies that are potentially effective in building high performance HCOs. They come from a variety of fields behind computer science and medical informatics, e.g. from business and organization sciences to psychological and cognitive sciences, from epistemology to sociology. However, the success in developing future Health Information Systems (HIS) requires their incorporation into a new conceptual framework after recognizing how peculiar are the characteristics of HCOs with respect to other organizations. Investigating the nature of knowledge, in general, and of medical knowledge, in particular, is essential to define which services the future HIS should provide to foster collaboration between patients and health professionals. The knowledge creation process is then described in order to emphasize its dynamic and social characteristics. The potential of workflow technology for building innovative HISs is analyzed together with several basic research issues which are very challenging for researchers in the field. A framework for augmenting the conceptual analysis of theories, methods, tools and effects of knowledge management in building high performance HCOs.

BACKGROUND AND CONTEXT: The province of Ontario in Canada, like many other jurisdictions globally, has identified a vision for healthcare that involves “a modern, sustainable and integrated health care system that is centred on the patient.” In addition to person-centred integration, efficiency and alignment of data, services and financial incentives, innovation, and capacity development were identified as key areas of focus. Ontario Health Teams (a group of healthcare providers and organizations that are responsible, both clinically and fiscally, for delivering a fully coordinated continuum of care to a defined geographic population) were developed as a primary vehicle to deliver this focus. This vision and mandate require significant health system transformation, at a time when our health care system is facing significant challenges: increasing acuity and complexity of health and social needs, a fatigued and stretched workforce, and a fiscally constrained environment. Value-creating learning health systems (LHS) are increasingly being looked to as an organizing framework for driving improvements in population health management, accelerating learning and improvement, breaking down silos and facilitating interoperability, and supporting data-driven insights and improvement. WORKSHOP OUTLINE (90 Minutes) 1) Introduction to Value-creating Learning Health Systems (10 minutes) The concept of a learning health system (LHS) was first introduced by the Institute of Medicine in 2007 as a system where “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”. While there have been many iterations since then, learning health systems share common elements: a clear articulation of the desired outcomes (often articulated as a health equity-driven quadruple aim), incorporation of a learning health cycle (which includes data to knowledge, knowledge to practice, and practice to data), ecosystems of change (which identify level and scale), supporting pillars (e.g., relationships, technology, policy), and shared core values (Menear et al, 2019). 2) Use of the LHS framework (20 minutes) Participants will be briefly introduced to 3 examples of application of the LHS framework that vary in scale and scope: -Refresh of a Regional Geriatric Program -Cross-OHT collaboration on enablers for integrated care -Establishing a provincial coalition for the development of population health management enablers Participants will be asked to reflect on these use cases, and to compare and contrast implementation across different contexts and settings. 3) Application of the LHS framework (40 minutes) Working in small groups, participants will be asked to consider a use case from their own jurisdiction and using a series of generative questions related to the LHS framework, identify current and future initiatives aligned with the LHS components, that would further their journey towards integrated care. 5) Report back and Summary of Lessons Learned (20 minutes)

Building a learning health system (LHS) at a federally qualified health center (FQHC) can generate research with diverse communities. However, FQHCs face challenges in integrating research with their mission to deliver high-quality primary care to vulnerable populations. Our FQHC serves over110,000 patients annually and partners with an academic medical center. We have implemented LHS strategies to align research with health care service priorities, enable clinician involvement in research, support data analysis, disseminate findings, and seek research funding. Drawing on the Consolidated Framework for Implementation Research, we identify contextual factors that impeded or facilitated our LHS implementation. Lessons can inform LHS practice in safety-net primary care. Case study of LHS development at an FQHC. FQHC leaders, clinicians, staff, and academic partners. APPROACH: Descriptive analysis of 168 research proposals and 13 grant-funded studies. Review of procedures to approve, implement, and disseminate research. Supportive leadership, preexisting culture of continuous QI, academic partners who understand the FQHC mission, and investment in research infrastructure (e.g., structured research review and access to data) facilitated the implementation of our strategies to integrate research with health care delivery as part of building an LHS. Inherent characteristics of research can pose challenges for research-practice integration, e.g., research often runs on longer timelines than quality improvement initiatives. Importantly, our approach is modular and iterative: we selectively and progressively launched strategies for LHS development, beginning with essential processes to review research, administer grants, provide data, and share findings. Alongside continually enhancing these processes, our work ahead includes building clinician and staff competencies for research, extending data analyst capacity, and establishing an organizational policy on equitable patient and community engagement in research. Taking a modular approach and iterating LHS activities can enable FQHCs to integrate research with health care service delivery in safety-net primary care.

Learning health systems (LHS) may improve healthcare access, innovation, coordination, continuity and quality. To ensure implementation success, healthcare organizations must be able to assess their current readiness to adopt an LHS approach; however, there is a paucity of LHS-specific readiness tools in the extant literature. Thus, the overarching aim of this study was to map the depth and breadth of LHS literature to identify the domains and items, alongside barriers, facilitators, implementation strategies and competencies relevant to include in an LHS readiness tool. A scoping review informed by Arksey and O'Malley's framework and updates proposed by Levac etal. was employed. Scopus, MEDLINE, Embase, CINAHL, PsychINFO, Education Source and Business Source Complete were searched from inception to May 2024. English or French publications that addressed the definitions, frameworks, competencies, barriers and facilitators of an LHS were eligible. The bibliographic database search and screening process yielded 90 articles, published between 2007 and 2024. A total of 72 articles defined LHS, with most emphasizing continuous learning cycles, evidence integration, infrastructure and stakeholder engagement. In addition, 56 articles presented 21 frameworks (educational, logic, maturity, organizational, equity and implementation), and 50 described key domains, including the D2K-K2P-P2D cycle, core values, and leadership, governance, and data infrastructure. Barriers to implementation included limited resources, unsupportive culture, poor interoperability and ethical challenges, while facilitators were strong leadership, shared purpose, robust partnerships and supportive policies. Identified competencies spanned research, informatics, quality improvement, systems science, engagement and ethics, with educational strategies ranging from collaboratives and training programs to graduate curricula and peer learning. Readiness and maturity assessments were discussed in 28 articles, but only a few operationalized these concepts. No specific LHS readiness assessments were identified. Current readiness tools derived from quality-improvement contexts may be helpful but not sufficiently specific for assessing healthcare organizations' readiness to implement an LHS approach. This review identified important barriers, facilitators, and strategies related to the collective behaviour change required to implement an LHS approach that should be considered in the future development of an LHS readiness assessment.

The decision-making management in health care organizations is one of the basic components of their efficiency. However, there is imbalance between requirements of everyday practice and scientific rationale of process under consideration, in particular lacking of appropriate criteria-diagnostic apparatus causing certain difficulties in decision-making. The purpose of the study was to design automated multi-criteria method of evaluating success of decision-making management in health care organizations. The survey of 62 experts, health care managers, was carried out. 23 criteria for evaluating success of decision-making management in health care organizations have been defined as well as their gradation and significance, integral model options, i.e. the multi-criteria evaluation method has been designed. The automation of method on "1C: Enterprise" software greatly facilitates assessment of not one but a number of health care organizations enabling their ranking. The machine processing results in integral evaluation and informative criteria determining it thus making possible search of case causes and ways of correction. The obtained results can be applied in daily procedures and training of executives of health care organizations.

Tackling Health Disparities in Radiology: A Practical Conceptual Framework.

Learning health systems