People and culture: at the heart of the evolution of learning health systems

Current health systems struggle to convert evidence into clinical practice. Case in point, some 60% of care is provided in accordance with evidence-based guidelines. Learning health systems (LHSs) have been proposed as a solution to this persistent problem. LHSs ideally incorporate data from all sources (e.g., patient data and research findings) to create knowledge that improves the affordability, safety, and quality of healthcare. Developing an LHS requires integrated IT systems, appropriate incentives, strong patient-clinician partnerships, and a workforce skilled and empowered to continuously learn. This chapter examines the organisational cultural factors that support or impede the development of an LHS. The findings are based on a scoping review of the literature from 2016–2021 and are supplemented by a rapid review of LHS responses to climate change and pandemics from 2018–2023. Both reviews extracted data based on the four dimensions of the Institute of Medicine’s (IoMs) 2013 Learning Health Care System framework (Science and Informatics, Patient-Clinician Partnerships, Incentives, and a Continuous Learning Culture) and used inductive and deductive thematic analyses. Then, prominent theories of organisational change were applied to understand the associated implications for the health workforce. In both reviews, Science and Informatics was the most frequently addressed barrier and enabler, with a central theme of co-designing IT systems with the health workforce. Although the other IoM LHS dimensions did not receive the same attention, both reviews revealed how a skilled, enabled and empowered health workforce that is engaged in shared decision making with patients and is appropriately incentivised and trained underpins every LHS dimension. Shifts in cultural norms, collaboration across disciplines and health sectors, and building long-term sustainable workforce capacity will also be needed to support a continuous learning culture. Developing an LHS-ready organisational culture would go a long way towards increasing the amount of healthcare provided in accordance with evidence-based guidelines.