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Framework to optimise learning network activities for long-term success
  1. Katherine E Bates1,
  2. Nicolas L Madsen2,
  3. Anne Lyren3,
  4. Paige Krack4,
  5. Jeffrey B Anderson4,5,
  6. Carole M Lannon4,6,
  7. Sharyl Wooton4
  1. 1 Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA
  2. 2 Pediatrics, University of Texas Southwestern Medical School, Dallas, Texas, USA
  3. 3 Pediatrics and Bioethics, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
  4. 4 James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  5. 5 Cincinnati Children's Hospital Medical Center Heart Institute, Cincinnati, Ohio, USA
  6. 6 The American Board of Pediatrics, Chapel Hill, North Carolina, USA
  1. Correspondence to Dr Katherine E Bates, Pediatrics, University of Michigan Medical School, Ann Arbor, MI 48109, USA; kebates{at}

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Learning networks (LNs) have demonstrated success as a useful model for building a learning health system, envisioned by the National Academy of Medicine as a system in which innovation and continuous improvement are achieved through stakeholder alignment and in which both known best practices and new knowledge generation are embedded in healthcare delivery processes.1 The results-oriented LN model has become increasingly popular in paediatrics, where there is often a lack of evidence-based best practices. Paediatric LNs aim to improve outcomes and generate new knowledge by using an actor-oriented network structure composed of multiple care sites, a group of varied stakeholders (including patients, families, clinicians, researchers and health system leadership) and use of data for improvement, research and innovation.2 Establishing an effective LN requires intentional design to achieve alignment around a common goal, build standard processes and infrastructure that enable collaboration, and create a shared commons for information exchange.3 This network architecture enables LNs to study variation across sites, test ideas to improve outcomes, identify best practices from these ideas and then enhance efficient dissemination of these best practices across sites.3 4 Using this model, several paediatric LNs have reported significant and sustained improvements in outcomes, including decreased incidence of healthcare acquired conditions,5 increased rates of inflammatory bowel disease remission6 7 and reduction in mortality of infants with high-risk congenital heart disease.8

As emphasised by Britto et al, because not all improvement interventions work equally well, LNs must have methods to test ideas to determine which interventions work best.3 However, despite the importance of this observation, the mechanisms of testing or learning that occur within an LN have not been previously described. Here we describe the learning and improvement (L&I) framework, a proposed framework that organises the types of L&I that occur …

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  • Contributors KEB and SW designed the learning and improvement framework, drawing on ideas from working with each of the coauthors and networks described in the manuscript. KEB drafted the manuscript and is responsible for the overall content as guarantor. All authors contributed ideas to the draft, critically reviewed the manuscript and approved the draft.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.