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Evaluating for learning and sustainability (ELS) framework: a realist synthesis
Marissa Bird1,2, Maura MacPhee3, James Shaw4
1Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada. marissa.bird@thp.ca.
BMC Health Services Research
|May 13, 2025
Summary
Evaluations in Learning Health Systems (LHS) can foster innovation sustainability by incorporating organizational readiness and feedback loops. Understanding these factors is key for effective health system improvement and learning.
Area of Science:
- Health Services Research
- Implementation Science
- Organizational Learning
Background:
- Learning Health Systems (LHS) aim for continuous healthcare improvement, optimizing practices, outcomes, and costs.
- Evaluation of health innovations is crucial within LHS for identifying questions, collecting data, and guiding actions.
- While evaluations can catalyze learning and sustainability, factors influencing their effectiveness remain unclear.
Purpose of the Study:
- To understand evaluative contextual factors and mechanisms supporting health system learning and sustainable innovation implementation.
- To identify why and how evaluations succeed or fail in fostering learning and sustainability within LHS.
- To provide evidence-based strategies for optimizing evaluation in health systems.
Main Methods:
- A realist synthesis was conducted, drawing from implementation science literature.
- An Expert Committee guided the five-stage review process: scoping, theory building, evidence identification, appraisal, and synthesis.
- Iterative cycles of results interpretation and feedback were employed by the Review Team and Expert Committee.
Main Results:
- Sixty articles were synthesized, identifying mechanisms and contextual factors for learning and sustainability through evaluation.
- Effective evaluations require favorable organizational preconditions and rapid, cyclical feedback loops.
- Six Context-Mechanism-Outcome Configurations (CMOCs) were identified, including embracing risk, increasing evaluation capacity, co-producing evaluation, implementing feedback loops, creating a sustainability culture, and becoming a learning organization.
Conclusions:
- Key factors and mechanisms determining evaluation effectiveness for learning and sustainability were identified.
- Findings translate CMOCs into actionable strategies to support LHS operationalization.
- The study provides a framework for improving evaluation to enhance health system learning and innovation sustainability.
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