Adopting a problem-focused rapid-learning and improvement orientation in health systems presents an opportunity for constant and iterative improvements in patient care and experiences across a number of chronic conditions. Rapid learning can take place at all levels of a health system (self-management, clinical encounter, program, organization, local and provincial health authority, and government), however, there are at least two different ‘ways in’ to establishing and strengthening the characteristics required to support rapid learning and improvement. The first is through a focus on a local area (e.g., an entire provincial health system) while the second is through a prioritized problem (e.g., a specific set of conditions).
The IMAGINE Network’s KT Working Group, led by Dr. John Lavis (McMaster Health Forum) in collaboration with the Chronic Pain Network (CPN), and CHILD-BRIGHT, organized, financially supported, and convened a citizen panel (January 2020) on the subject of supporting rapid learning and improvement for select chronic conditions in Canada, followed by a stakeholder dialogue on the same subject (February 2020) that was informed by the insights captured at the panels. The panels brought together a total of 12 citizens from across Canada (from five provinces, namely British Columbia, Alberta, Ontario, Quebec and Nova Scotia), and the dialogue brought together 17 participants – policymakers and managers, healthcare professionals, stakeholders, and researchers – from across Canada to examine the problem, elements of a potentially comprehensive approach for addressing it, and key implementation considerations. The thematic insights and values underpinning citizens’ views about and experiences with key issues related to problem-focused rapid learning and improvement were captured in a panel summary, and the insights from the dialogue were captured in a dialogue summary.
Key insights emerging from the citizen panel and stakeholder dialogue include:
- Panelists identified a range of important challenges that were linked to their own care experiences (e.g., access to their providers and health data, inadequate or incomplete care, access to information on their condition).
- Panelists identified the need for better supports for engaging patients in identifying strengths and weaknesses in health systems. This could include creating tailored patient information about assets and gaps in health systems and creating space for them to share feedback with stakeholders.
- Panelists discussed that in order to observe improvements and progress from health-system changes, there is a need to establish mechanisms that ensure realistic and meaningful targets are set that relate directly to improving patient care and experience.
- Panelists identified limited resources (both human and financial) as one of the biggest barriers to supporting rapid learning and improvement for select conditions. They also expressed their doubts on health system actors’ willingness to move away from the status quo to embrace a mindset conducive to continuous learning and improvement. In discussing potential strategies to move forward, panelists identified ways for the health system to engage patients, such as involving them in roundtable discussions with stakeholders, drawing on their lived experiences to design relevant decision supports, and co-creating timely and relevant evidence through patient-oriented research opportunities.
- Participants generally agreed that the four aspects of the problem outlined in the evidence brief captured important aspects of the challenges inherent in establishing rapid-learning health systems (i.e., opportunities exist but aren’t always acted on, some problems (or conditions) may not be prioritized or resourced centrally, other system initiatives can detract focus from a particular problem, and not all assets are in place or well connected).
- Participants suggested three next steps: 1) develop a succinct and compelling ‘elevator pitch’ to engage key stakeholders; 2) build networks and an approach for developing the next generation of champions; and 3) use existing success stories as a platform upon which to move ahead with additional efforts across Canada.
The results of the project have been made available for free download on the Forum’s website with links from the IMAGINE website and disseminated via IMAGINE & the Forum’s e-newsletters and social media channels (reaching an audience size of 10,000 users). An email service was also created in Health Systems Evidence for broader engagement of policymakers, stakeholders and researchers with an interest in staying apprised of the latest synthesized evidence published on the topics addressed in the project.