No one in DAR would be surprised to hear me say that I see analytics at the center of a learning process. That one learns through the process of an analytic project is one of its most exciting (and sometimes frustrating) aspects.
How many times have you run a 'simple' analysis to finish off a project and the data told you something totally unexpected and made you scratch all of your work and start over? This happens to me from time to time, so much so that when I am finishing a project, I often find myself afraid to look at the last bit of output because I DON'T WANT TO START OVER. I want to be done with the learning already, and get onto the work of doing.
When DAR delivers a data sheet or analysis to one of our requesters, one of two things happens more than 70% of the time -- the requester learns something new from the analysis and, as a result, asks DAR for more analysis or more data OR they realize that they did not ask for the thing that would answer their questions, and then asks DAR for more analysis or more data. Try as we might to prepare people for what they will get, the learning process is fundamentally unpredictable.
The reality of the work DAR does puts us square at the center of Lurie Children's "learning healthcare system." And whether we know it or not, whether we acknowledge it or not, whether we embrace it or not, I think that is what we have -- a hospital system teeming with earnest learners who are trying to do their jobs better, trying to improve care, and trying to uncover new ways of treating patients. Lots and lots of times, those earnest learners come to DAR for help.
I wondered if it would be helpful to talk about the learning healthcare system idea a bit, so that others around the hospital might consider how they participate in it, perhaps without even being aware. With all of the change Lurie Children's is going through, I find the learning healthcare system a framework helps me stay focused on the right things, and gives me the patience to go through all the ups and downs that learning involves.
The notion of a learning healthcare system has been kicked around between a couple different disciplines over the last 15 or so years (IT, research, QI). A really great document was produced two years ago that ties a lot of pieces together. This report defines seven roles in the learning healthcare system of the UK's National Health Service, diagramed above. Here is how I see the linkage between that diagram and Lurie Children's:
|Learning Healthcare System Role||Some initiatives at Lurie Children's that fill the roles||How the role is filled by the initiative|
|Committed and respected leadership engaging the staff||Power of All||The campaign focuses on many things, including discovery and innovation, and striving for excellence.|
|A culture hospitable to and supportive of change||Vision 2025||The strategic plan explicitly lays out changes that we hope to achieve and enables those changes by setting clear priorities (we cannot do everything).|
|Data and analytics that measure and communicate progress||DAR's analytic roadmap||The roadmap was adopted a couple years ago by the hospital. Its goal is to help faculty and staff understand problems and measure progress in addressing them.|
|Management practices that ensure execution and implementation||Enterprise Project Management Office (EPMO)||The new model of project management and prioritization through the EPMO has built our capacity to prioritize initiatives and hold ourselves accountable for achieving them.|
|An enabling environment which supports and drives change||Annual goal setting process||This process has been revamped recently, and bring leaders and key staff from across the organization to set priorities for the coming year, and assess our progress.|
|Resources and support to do the work of change||Center for Excellence
CFE QI Scholar's Training
|The Center for Excellence supports quality improvement and process improvement across the organization. The QI Scholar's Training builds these skills in professionals across the organization so they can promote quality improvement in their own areas.|
|Capabilities and skills to identify and solve problems||Center for Excellence
DAR's analytic fluency efforts
Research Strategic Initiatives
|Both the Center for Excellence and DAR work intensively with faculty, staff and leaders across the organization who are trying to improve care, processes, or services. The Research Strategic Initiatives are building capacity to expand our research efforts, qualitatively and quantitatively.|
The authors of the NHS report indicate that there are five 'building blocks' of a learning healthcare system:
Data within the healthcare system: These include EHR data, as well as data in all of the applications that bear on hospital operations and patient care. If you work with data from our EHR, you know that it can be problematic. So part of the goal of the learning healthcare system is to record data in an analyzable format.
Data outside the healthcare system: These data may include community-based data, environmental data or financial data that can provide insight into how health is improved or imperiled.
Outcome measurement: We focus on patient outcomes a lot at this hospital, which is appropriate. But outcome measurement is not just about patients – when we take on a new project of any kind, we ask 'How will we know whether we are successful?' We acknowledge that almost all of our efforts will tie back to improving patient care even if they see far removed from the patients.
Behavior change: A learning health system needs to embrace and enable the behavior changes that are required to improve care. Sometimes, providers need to change, sometimes, patients do, and sometimes, administrators do. But a learning healthcare system cannot be functional without individuals being willing to change the way they do business.
An ethical framework to guide change: Putting the needs of patients first and giving them a voice in the changes around them are two key ways we apply an ethical framework in the learning healthcare system.
The NHS report provides another diagram that is also helpful, and it shows a unified process for learning, whether the learning happens as part of a process improvement effort, a research study, or an evaluation of a program's effectiveness.
The blue side of this circle focuses on the process of gathering, analyzing and organizing information, leading to a key insight (interpretation). The red side explores the more active process of choosing a path forward and implementing change. If you have been through one of these processes, you know well that there is plenty of back and forth between the five steps the diagram sets out. But in general, we work towards the positive progress of learning, applying what we learn and improving the quality of our work.
My opinion is 'Yes, we do.' That is because, from my vantage point, I see this learning and improving going on all day every day. All DAR staff members are up to their elbows in it.
Learning creates disruption and change, which can be frustrating to many of our staff, faculty and even patients. But learning itself is a good core principle that we can all get behind when we face the anxiety that comes with change.
Reframing the change as learning, and valuing and protecting the learning process (which needs to take its own time and wander in whatever directions it needs to go), can help us see the change we are going through in a more promising way. We know we are working toward improvement, not just change for change's sake. And we know that learning takes time, and will not always happen in a simple, straight line.
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