Building a COVID-19 Regional Learning System from the Bottom Up

Published April 2021 | Mayo Clinic Proceedings

The sudden explosion of COVID-19 cases in the United States required nearly every healthcare organization in the country to adapt and respond to the worst public health crisis since the 1918 influenza pandemic.

In the Cincinnati region, which spans 14 counties in three states, that meant building an effective response team from the leaders of 22 otherwise highly competitive hospitals, 17 local health departments, and numerous school districts, chambers of commerce, senior services, jails, shelters and other organizations. It was exactly the kind of challenge that the experts of the James M. Anderson Center for Health Systems Excellence were assembled to address.

“Although response plans existed across jurisdictions and institutions, they were insufficiently linked,” says first author Andrew Beck, MD, MPH. “We quickly saw a need to use design and change management strategies and a network organizational model to organize a learning health system ‘team of teams.’ ”

The teams co-designed responses to address hospital surge capacity and shortages of personal protective equipment. They supported shared funding for special projects, a centralized communications approach, and a regionwide data dashboard. Then they kept learning and adjusting.

“What was appropriate on day 1 was not on day 30,” says Peter Margolis, MD, PhD, co-director of the Anderson Center. “We employed structured improvement methods to rapidly address emerging questions such as how to establish outdoor testing sites in cold weather, where to locate sites to optimize equitable access, and how to communicate to diverse populations.”

The region’s COVID-19 Multi-Agency Coalition ultimately navigated pandemic response throughout a highly politically charged environment with a structure that could have lasting ramifications. 

“There is now an opportunity to build better national infrastructure by learning from hundreds of small-scale responses like ours,” Margolis says.

COVID-19 Incidence in Greater Cincinnati

Annotated chart depicting daily case incidence, measured per 100,000 population, with a 7-day moving average. Light blue lines indicate mitigation-oriented interventions. Dark blue lines indicate background changes likely influencing viral transmission.