Measuring Maturity: Development and Validation of the Learning Health System Self-Assessment Tool

The Learning Health System (LHS) concept holds significant promise for continuous, data-driven improvement in healthcare, yet operationalization at scale remains elusive. LHS maturity can be conceptualized as the extent to which organizations demonstrate essential capabilities. Current tools to assess LHS maturity have limited scope, and a rapid, multi-stakeholder tool to assess organizational-level LHS maturity remains lacking.

To address this gap, we developed a maturity self-assessment tool mapped to the LHS Action Framework by Reid and colleagues that operationalizes LHS maturity as capability levels across five core learning activities and selected infrastructure supports. Using design science and participatory action research, we conducted five sequential development steps: (1) item bank creation, (2) prioritization and refinement by the core research team, (3) expert panel review, (4) cognitive interviews with interprofessional decision-makers, and (5) pilot testing in a real-world setting. Each step incorporated participant feedback to refine and streamline the tool.

The resulting tool consists of 41 items assessing the extent to which LHS activities occur across the LHS Action Framework's five learning activities and supporting infrastructure. Preliminary findings from a national Emergency Department LHS assessment (n = 53 responses from 33 sites) demonstrated the tool's feasibility and acceptability in a real-world setting, and its ability to identify capability gaps across the LHS Action Framework's constructs.

The self-assessment tool provides a foundational measurement approach to guide LHS development, representing a critical step toward developing a comprehensive LHS maturity model. By facilitating a shared understanding of the LHS and enabling self-assessment of the current-state capabilities as core LHS maturity indicators, the tool may support evidence-informed and collaborative strategic planning for a variety of health system configurations. Future research should evaluate the tool's generalizability across diverse contexts and utility for tracking developmental progress over time.