What are the key elements of a learning system and how can they help improve patient care?

By Frank Federico, Institute for Healthcare Improvement

Frank Federico is a senior patient safety expert and Institute for Healthcare Improvement (IHI) faculty. He is a pharmacist by training and has co-chaired many IHI collaboratives.

The four pillars of the learning system
Frank Federico at the first learning session of the Safe Care Collaborative.

The learning system supports rapid learning and the use of data and improvement methods to remove defects and provide the best care possible for patients. It is the technical backbone of the Institute for Healthcare Improvement’s Framework for Safe, Reliable and Effective Care. There are four elements that make up the learning system:

  • transparency
  • reliability
  • improvement and measurement
  • continuous learning

Some people think of continuous learning as continually developing their own skills, perhaps their clinical skills. Continuous learning is the heartbeat of a learning organisation. It ensures that improvement methods are not just taught but ingrained, accompanied by measures for improvement. Continuous learning is learning from what has gone well, and also what has not gone well, for example results from investigations or near misses. This allows you to get the processes and outcomes you want. You have to design processes that are reliable so that each and every time we are getting results. Transparency is the ability to share information, so that people at the point of care can see their own performance and can use data for learning. Transparency also includes people being able to have open discussions.

Teams across Wales have the opportunity to learn to use and improve their own learning systems through the Safe Care Collaborative. The collaborative provides a testing bed and a mechanism for teams to learn how to make things better and enhance their learning system.

Creating the culture of a learning organisation

The effectiveness of the learning system relies on an enabling environment that promotes learning from both qualitative and quantitative data without fear of judgment or punishment. Leaders at all levels play a pivotal role in creating this culture, allowing the learning organisation to flourish and fostering an environment where information is shared openly, and discussions are rooted in a commitment to improve.

The role of leaders

The learning and improvement system won’t work unless leaders are committed to supporting learning at every opportunity. Leaders must fully understand, encourage and apply the concepts of improvement, reliability and continuous learning.

There needs to be an understanding that most mistakes are systemic, so blame and punishment need to be removed. Leaders must set the tone and improvement teams have to be willing to share data to learn when things go wrong, it is an opportunity to understand why.

Sources of learning

Learning doesn’t reside in a vacuum, look at various sources – performance and operational data, cultural insights, clinical data, and conversations. You need to tap into this wealth of information, encouraging teams to share data and lessons learned transparently so that learning can happen.

The success of the learning system lies in integrating it seamlessly into your work. In organisations that have been successful with their learning system application, people see it as just a way of working. It’s about recognising that improvement is a constant, not just fixing defects, but striving for efficiency and excellence in every aspect of your role.

Reflect on your commitment to the learning system

Challenge yourself to apply continuous learning, improvement and measurement, reliability, and transparency in your daily work, and commit to becoming an active participant in the journey towards safer, reliable, and effective care.