Table 1.
University of Wisconsin (UW) Health organizational changes and core components of the learning health system
| Change Domains | Organizational Capabilities of the Learning Health System[Link] | New UW Health Organizational Infrastructure Supporting the Learning Health System | Examples |
|---|---|---|---|
| Goals and strategies |
•Identify problems and potential solutions •Prioritization •Organization •Funding •Align incentives •Ethics and oversight |
•Integrated strategic planning process •Integrated governance structure to establish enterprise‐wide improvement goals and provide oversight •System‐level quality department •Internal pay for performance program |
•Regular presentations to organizational leadership •Integrated 3 separate quality improvement departments to create the single UW health quality, safety, and innovation department •One‐page UW health scorecard communicating annual improvement goals for inpatient and ambulatory care in patient experience, clinical metrics, and costs •UW Health Quality Council chaired by chief executives of faculty practice and hospital members included chairs from all academic departments and senior leaders in nursing, operations, and IT. |
| Culture |
•Patient and family engagement •Culture of learning supported by leaders |
•Patient‐ and family‐centered principles consistently guide redesign initiatives •Patients engaged as partners in redesign •Senior leadership supported strategic plan |
•Patient engagement microsystem training program—47 teams engaged patients as members on improvement teams. •More than 150 patient and family advisory councils established (see Figure 4)12, 13, 14 •Internal policy work, including establishing protocols for patient volunteers (eg, childcare and transportation) and HIPAA privacy |
| People and processes |
•Design •Implement •People and partnerships •Clinician‐patient partnership |
•Leadership dyads (physician leaders and clinic/inpatient unit managers) •Established multisectoral partnerships •Standardized care models |
•Program was initiated with 41 primary care dyads and 42 inpatient dyads •Standard care models for previsit planning, office visits including role optimization, and chronic care management are developed and have been sequentially implemented across primary care sites. •Developed an innovation grant program with insurance partner15 |
| Learning infrastructure |
•Evaluate •Adjust •Disseminate •Data and analytics •Evaluation and methodology •Deliverables |
•Transparent performance reporting •Center to evaluate evidence and maintain system‐level knowledge base •Care Model Oversight Committee •Standard training and education in improvement science •Multidisciplinary university partnerships for research and education |
•Center for Clinical Knowledge Management allowed for system‐level quality work and established practice guidelines, clinical decision‐support tools, and nurse delegation protocols and a system for ongoing knowledge management •Maintenance of Certification Portfolio Program •Worked with Health Innovation Program, multidisciplinary patient advocacy center/law, department of industrial and system engineering, and department of economics |
| Technology | •Science and informatics providing real‐time access to knowledge and data | •EHR embedded tools for clinician and patient decision making |
•Health maintenance best practice alerts •Registries established •Patient portal •EHR user optimization16 |