Achieving the Vision of a Learning Healthcare System

Published November 2018 | BMJ Quality & Safety

Too often, our healthcare system is error prone and costly while failing to meet patient and family needs. Finding ways to improve the system, using reliable data, has been an unrealized quest for many organizations.

However, over a period of 13 years, experts at Cincinnati Children’s have built what they describe as a “network framework for Learning Healthcare Systems” that allows systematic quality improvement to be implemented at scale. A report led by first author Maria Britto, MD, MPH, and senior author Michael Seid, PhD, lays out the process and cites several examples of real-world success.

Other Cincinnati Children’s co-authors include Sandra Fuller, MEd, Heather Kaplan, MD, Uma Kotagal, MBBS, MSc, Carole Lannon, MD, Peter Margolis, MD, PhD, Stephen Muething, MD, and Pamela Schoettker, MS.

Successful learning networks have three essential components: aligning participants around a common goal; establishing standards, processes, policies and infrastructure to enable collaboration; and a “commons” where information, resources and know-how can be shared.

Examples of networks that work include the Ohio Perinatal Quality Collaborative, which helped reduce early elective C-sections; ImproveCareNow, which accelerated higher remission rates in inflammatory bowel disease; Children’s Hospitals’ Solutions for Patient Safety, which reduced catheter-associated urinary tract infections; and the National Pediatric Cardiology Quality Improvement Collaborative, which reduced mortality for infants with single-ventricle congenital heart disease.

“We have observed improvement in outcomes across multiple diseases and conditions and across participating sites with diverse contexts. While these examples focus on pediatric conditions and issues, the principles should be generalizable to conditions across all of healthcare,” the co-authors state.