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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 …
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.
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