From "Invented here" to "Use it everywhere!": A Learning health system from bottom and/or top?

Area of Science:

• Healthcare Management
• Health Services Research
• Organizational Learning

Background:

• Digitalization offers potential for improving healthcare quality and efficiency.
• Learning Health Systems (LHSs) provide a framework for accelerating healthcare innovation and quality improvement.
• Adapting LHS concepts to existing organizational structures is crucial for successful implementation.

Purpose of the Study:

• To investigate the application of the Learning Health System (LHS) concept within an existing healthcare organization.
• To translate and adapt the LHS model to local circumstances in psychiatric departments.
• To improve healthcare practice and advance scientific understanding of LHS implementation.

Main Methods:

• A one-year longitudinal action research (AR) study was conducted in five psychiatric departments.
• Holistic data collection included field notes, documents, recordings, and workshops.
• Data analysis employed an insider-outsider approach.

Main Results:

• A locally adapted LHS model was developed by iteratively matching practical needs with theory.
• A conflict between top-down (uniform solutions) and bottom-up (local learning) development views emerged.
• A negotiated solution balancing these approaches was created, comprising technical and organizational components.

Conclusions:

• The conflict between top-down and bottom-up implementation approaches requires careful consideration in practice and research.
• Translating LHS concepts to real-world settings, rather than instrumental implementation, is advantageous.
• Action research projects provide a strong foundation for developing practical and effective LHSs.