Multi-level analysis of the learning health system: Integrating contributions from research on organizations and implementation.
Multi-level analysis of the learning health system: Integrating contributions from research on organizations and implementation.
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DOI：
10.1002/lrh2.10226
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发表时间：
2021-04
影响因子：
3.1
通讯作者：
Shortell SM
中科院分区：
文献类型：
--
作者：
Harrison MI;Shortell SM
提供医疗保健的组织和系统可以通过充当学习型组织和学习型医疗系统（LHS）来更好地适应环境的快速变化。尽管人们普遍认识到，多层次的力量塑造了医疗机构的学习能力，但没有一个商定的、全面的、多层次的框架来指导LHS的研究和实践。我们开发了这样一个框架，它可以加强对LHS的研究和实际步骤，他们的发展。我们借鉴了组织和实施科学中现有的框架和研究，并综合了三个有影响力的框架的贡献：实施研究的综合框架，社会生态框架和组织变革框架。这些框架分别来自实施科学、公共卫生和组织科学领域。我们提出的综合框架包括组织内层面（个人、团队、中层管理人员、组织）以及交付组织运营的运营环境和一般环境。我们强调研究系统内和系统间影响因素之间的相互作用的重要性，并关注领导力，激励措施和文化的影响。此外，我们指出，组织学习在很大程度上取决于这些因素的内部和跨层次的对齐。我们说明了我们的多层次的角度来看，通过应用它来分析三个不同的实施举措，旨在具体的护理改进和持久的系统学习的贡献。这里开发的框架和观点可以帮助调查人员和从业人员广泛扫描，然后调查影响改进和学习的力量，并可能指向影响因素之间的相互作用。该框架还可被管理人员和从业人员用作规划工具。
Organizations and systems that deliver health care may better adapt to rapid change in their environments by acting as learning organizations and learning health systems (LHSs). Despite widespread recognition that multilevel forces shape capacity for learning within care delivery organizations, there is no agreed‐on, comprehensive, multilevel framework to inform LHS research and practice. We develop such a framework, which can enhance both research on LHSs and practical steps toward their development. We draw on existing frameworks and research within organization and implementation science and synthesize contributions from three influential frameworks: the Consolidated Framework for Implementation Research, the social‐ecological framework, and the organizational change framework. These frameworks come, respectively, from the fields of implementation science, public health, and organization science. Our proposed integrative framework includes both intraorganizational levels (individual, team, mid‐management, organization) and the operating and general environments in which delivery organizations operate. We stress the importance of examining interactions among influential factors both within and across system levels and focus on the effects of leadership, incentives, and culture. Additionally, we indicate that organizational learning depends substantially on internal and cross‐level alignment of these factors. We illustrate the contribution of our multilevel perspective by applying it to the analysis of three diverse implementation initiatives that aimed at specific care improvements and enduring system learning. The framework and perspective developed here can help investigators and practitioners broadly scan and then investigate forces influencing improvement and learning and may point to otherwise unnoticed interactions among influential factors. The framework can also be used as a planning tool by managers and practitioners.
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DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
影响因子：
7.2
作者：
Birken, Sarah A.;Lee, Shoou-Yih Daniel;Weiner, Bryan J.
通讯作者：
Weiner, Bryan J.
影响因子：
5.4
作者：
Britto, Maria T.;Fuller, Sandra C.;Seid, Michael
通讯作者：
Seid, Michael
影响因子：
2.4
作者：
Antonacopoulou, Elena P.
通讯作者：
Antonacopoulou, Elena P.
影响因子：
5.2
作者：
Counte, Michael A.;Howard, Steven W.;Aaronson, William
通讯作者：
Aaronson, William