Citation, abstract, extract, key messages and comment from me below.
CITATION: Aiming for quality: a global compass for national learning systems
Diana Sarakbi, Nana Mensah-Abrampah, Melissa Kleine-Bingham & Shams B. Syed
Health Research Policy and Systems volume 19, Article number: 102 (July 2021)
Introduction: Transforming a health system into a learning one is increasingly recognized as necessary to support the implementation of a national strategic direction on quality with a focus on frontline experience. The approach to a learning system that bridges the gap between practice and policy requires active exploration.
Methods: This scoping review adapted the methodological framework for scoping studies from Arksey and O’Malley. The central research question focused on common themes for learning to improve the quality of health services at all levels of the national health system, from government policy to point-of-care delivery.
Results: A total of 3507 records were screened, resulting in 101 articles on strategic learning across the health system: health professional level (19%), health organizational level (15%), subnational/national level (26%), multiple levels (35%), and global level (6%). Thirty-five of these articles focused on learning systems at multiple levels of the health system. A national learning system requires attention at the organizational, subnational, and national levels guided by the needs of patients, families, and the community. The compass of the national learning system is centred on four cross-cutting themes across the health system: alignment of priorities, systemwide collaboration, transparency and accountability, and knowledge sharing of real-world evidence generated at the point of care.
Conclusion: This paper proposes an approach for building a national learning system to improve the quality of health services. Future research is needed to validate the application of these guiding principles and make improvements based on the findings.
'There is no single pathway to achieving quality UHC. Each country will need to learn how to transform its health system into a learning one to deliver quality health services to patients, families, and the broader community. A learning system is defined by the Institute of Medicine, the most common reference cited in the literature, as a system that learns from itself, where “science, informatics, incentives, and culture are aligned for continuous improvement and innovation, with best practices seamlessly embedded in the delivery process and new knowledge captured as an integral by-product of the delivery experience”. Real-world evidence generated at the point of care could help national health authorities understand the systemic barriers for delivering quality health services and the strategies and policies needed to address them.'
- There is an urgent need to understand how different health systems are developing the learning architecture required to implement national strategic direction on quality health services.
- This scoping review provides granular-level information that can be considered by those responsible for developing a learning architecture for quality health services.
- This scoping review has led to an approach to building a national learning system that requires shared priorities, collaboration, public trust and accountability, and knowledge sharing within and between countries.
- Future research is needed to validate the application of this approach and make improvements based on the findings.
COMMENT (NPW): The auhtors note 'There is potential to form a network with other learning systems globally around a common, complex healthcare challenge to foster cross-learning between countries as they build or strengthen their learning systems. A learning network is a group of learning systems operating at a national or global scale for mutual learning and improvement on a common priority theme.' HIFA has the potential to serve as a communication tool to facilitate such learning and sharing of experience and expertise. We are currently doing this through the WHO-supported HIFA project on Learning for quality health systems, based around a series of thematic discussions on the HIFA forums. In the medium and long term, HIFA's potential is dependent on our own ability to learn and improve as a communication tool, and we always welcome ideas on how we might do this. HIFA is also actively pursuing ways to promote cross-country learning with other communities of practice in global health (and beyond). In the past 2 years we have co-developed an active learning network of around 40 CoPs in global health, working together to increase our individual and collective impact.