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Applying the NASSS Framework to Learning Health Systems

The expert workshop found that the NASSS Framework could be applied to a broad range of Learning Health Systems. Moreover, the understanding gained could help select projects to fund, as well as aiding in their design, implementation and evaluation. Some NASSS domains will be more important than others for a given Learning Health System, while some may not merit consideration. The framework could be applied to the entire Learning Health System or separately to the components within an umbrella Learning Health System. It is likely to be most effective if used to guide a comprehensive discussion, rather being applied mechanistically.

The NASSS Framework has been deployed within a series of tools called NASSS-CAT (Complexity Assessment Tool) [132]. The NASSS-CAT Tools Box describes each tool and when it should be used. These tools should be applied to Learning Health System components as they are being designed, implemented and evaluated.


Greenhalgh et al. have developed three freely available versions of the NASSS-CAT Tools [132].

NASSS-CAT Long: A 16-page qualitative and quantitative assessment tool that can be used for project design, due diligence, planning and monitoring. It also includes components designed to shape the project [193].

NASSS-CAT Project: A four-page quantitative project monitoring tool for tracking, reducing and responding to subjective complexity as it changes over time [194].

NASSS-CAT Short: A three-page semi-quantitative short version [195].

Each tool guides the user through the process, enabling them to operationalise the NASSS Framework, even without extensive experience. The tools encourage discussion and co-design with the project stakeholders.

The aims of these tools are summarised in Figure H

Figure H The NASSS-CAT (Complexity Assessment Tool). Adapted from a presentation by Prof Greenhalgh to the workshop on applying NASSS to Learning Health Systems.