Using a network organisational architecture to support the development of Learning Healthcare Systems

Abstract

The US National Academy of Sciences has called for the development of a Learning Healthcare System in which patients and clinicians work together to choose care, based on best evidence, and to drive discovery as a natural outgrowth of every clinical encounter to ensure innovation, quality and value at the point of care. However, the vision of a Learning Healthcare System has remained largely aspirational. Over the last 13 years, researchers, clinicians and families, with support from our paediatric medical centre, have designed, developed and implemented a network organisational model to achieve the Learning Healthcare System vision. The network framework aligns participants around a common goal of improving health outcomes, transparency of outcome measures and a flexible and adaptive collaborative learning system. Team collaboration is promoted by using standardised processes, protocols and policies, including communication policies, data sharing, privacy protection and regulatory compliance. Learning methods include collaborative quality improvement using a modified Breakthrough Series approach and statistical process control methods. Participants observe their own results and learn from the experience of others. A common repository (a 'commons') is used to share resources that are created by participants. Standardised technology approaches reduce the burden of data entry, facilitate care and result in data useful for research and learning. We describe how this organisational framework has been replicated in four conditions, resulting in substantial improvements in outcomes, at scale across a variety of conditions.

Keywords: communication; continuous quality improvement; control charts, run charts; healthcare quality improvement; teams.

Figure 1

Key Driver Diagram for Ohio Perinatal Quality Collaborative (OPQC). ACOG = American College of Obstetricians and Gynecologists; CHW = community health workers; ED = emergency departments; MCP = managed care plans; OB - obstetric; PIP = progesterone improvement project; SMFM = Society for Maternal-Fetal Medicine; WIC = Special Supplemental Nutrition Program for Women, Infants, and Children

Figure 2

Key Driver Diagram for Children’s Hospitals’ Solutions for Patient Safety (SPS).

Figure 3

Patients in ImproveCareNow (ICN) with inflammatory bowel disease in remission.

Figure 4

Interstage mortality for infants with single-ventricle congenital heart disease in the National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC).

Figure 5

Catheter-associated urinary tract infections (CA-UTI) for patients in Children’s Hospitals’ Solutions for Patient Safety (SPS).

Figure 6

Scheduled (early elective) deliveries before 39 weeks’ gestation that lack a documented medical indication for patients in the Ohio Perinatal Quality Collaborative (OPQC).