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The Organisation

The organisation’s capacity and readiness for change will influence the uptake and scale-up of Learning Health System interventions internally. The decision on whether to fund and support a Learning Health System will be influenced by the business planning, yet it is often impossible to predict costs and benefits in advance. Many healthcare organisations are already working at capacity and are focused on relatively short-term financial, process and regulatory targets. There may be limited uptake for Learning Health System elements that are unaligned with these targets or demand upfront investment for long-term payback.

A Learning Health System is not just an IT project. Ideally, within a healthcare provider or even a national system, Informatics, Quality Improvement, Research, Library, Performance, HR, Training departments and others would be working together to deliver the Learning Health System strategy.

Elements of a Learning Health System that are viewed as a public good – such as the contribution of data to publicly funded research with open access to results – may be seen as a luxury, only affordable for organisations that trade on their national reputation or dominate their market [1]. Other organisations may require additional incentives to participate.

Organisational slack can make this process possible. The work involved in implementation is often extensive and underestimated at the planning stage, while there must be a shared vision about what the Learning Health System can realistically achieve. In some cases, innovation can be achieved by working with another, more innovative organisation.

Poor technical and support infrastructure meant that some organisations could not support HealthTracker. There was also a varying capacity for innovation and quality improvement, while the size and governance structure had an impact. Some small practices struggled to support the change, while others benefited from streamlined decision making. In other practices, inflexible job roles hindered use.

PatientsLikeMe sought but did not achieve adoption by existing healthcare organisations.

CYPHP is a clinical-academic programme functioning as an Active Learning Partnership. It brings together three Foundation Trust hospitals (including a mental health provider), primary care providers, local authorities, public health organisations, commissioners and a university institute. It is a formal partnership with shared decision-making and governance. Building trust took time but has resulted in profound change being embedded across the system. CYPHP is supported by a mixed funding model, including a hospital charitable foundation and local Clinical Commissioning Groups (CCGs). A twin-track evaluation programme includes both pragmatic NHS service evaluation and a rigorous research-standard evaluation, providing new knowledge about effective models of care for children and young people.

TRANSFoRm required cooperation from several EHR vendors for whom participation was not always a priority. This resulted in delays [37].