Principles for embedding learning and adaptation into New Zealand health system functioning: the example of the...

This article makes the case for taking a model-based management approach, specifically using the Viable System Model (VSM), to embed learning and adaptation into the New Zealand health system so it can function as a learning health system. We draw on a case study of a specialist clinical service where the VSM was used to guide semi-structured interviews and workshops with clinicians and managers and to guide analysis of the findings. The VSM analysis revealed a lack of clarity of organisational functioning, and of the systems, processes and integrated IT infrastructure necessary to support the fundamental requirements of a learning health system. We conclude that model-based management, specifically using the VSM, has significant potential for embedding the requirements for a learning health system into core functioning, including identifying technology infrastructure requirements. In addition, the VSM holds promise for improving clinical engagement and enhancing the health system's ability to achieve financial sustainability, high performance, distributed decision making and efficiency.