Lessons on Embedding LHS Research into Practice

I made banana bread yesterday to celebrate the 4th adoption anniversary of our husky/malamute Gorm (see here for his namesake--he is in my family tree and is the father of Herald Bluetooth). We rescued Gorm when he was 9 months old, and I'm confident he had no idea he would be flying half way across the world a year later. He had one amazing winter running in the snow before we moved and now swims in his free time. Banana bread is something I have only seen for sale in Australia and in huts along the remote road around West Maui when we biked 60 miles up and down dozens of steep hills (4,000 feet elevation gain) in a one-day grueling loop. Toasting banana bread is something I learned in Australia.

In late March, together with our external review, we will host a symposium on embedding informatics research into practice. A recent, relevant article was published in the Learning Health Systems journal titled Unpacking the challenges of conducting embedded, learning health system research: The winning entries of a Challenge Contest sponsored by AcademyHealth. The purpose of the contest was to "increase our collective capacity to engage in health services research embedded within healthcare organizations." I wanted to share a few interesting case studies that provide practical advice for embedding research in health services.

Embedded patient-centered research in 3 real-world, learning health systems: Challenges and lessons. UC San Diego

In this project, they addressed a challenge we see often that "Interventions requiring EHR build may not be implemented according to the research project's timeline when informatics analysts prioritize operational needs." To address this, they funded dedicated efforts to build EHR interventions and train users. Here are their lessons learned:

Embedded researchers serving alongside operations leaders in a health system contribute to effective LHS research. It was essential to have the study sponsored by multiple senior leaders. Their enthusiastic support facilitated clinic and clinician recruitment and the design and implementation of changes to the EHR and clinic workflows in each system.

Sustaining high adherence to lung-protective ventilation in a community-based learning health system. Intermountain Healthcare

They found a substantial disconnect between guidelines and practice in lung-protective ventilation and applied three new strategies:

(1) development of an agreed-upon, system-wide adherence metric, goals and real-time reporting adjusting for appropriate care adaptations;

(2) physician performance of a daily snapshot audit of key indicators during interdisciplinary rounds; and

(3) use of local process improvement teams empowering local sites to review case-level data and to identify and overcome local barriers to adherence. The organization achieved full adherence system-wide within 1 year and has sustained adherence for ≥2 years.

How research and operations partner to implement collaborative care for depression in large primary care settings. Kaiser Permanente, Southern California

This team implemented used the Institute for Healthcare Improvement (IHI) rapid improvement in healthcare systems framework as the main implementation approach:

(1) capacity building within the organization to adapt evidence-based interventions to address organizational concerns;

(2) providing several temporary Plan-Do-Study-Act (PDSA) learning cycles for people to “try out” change without committing large amounts of organizational resources for long periods of time; and

(3) allowing for incremental and dynamic change in that goals is revisited depending upon the feedback from the PDSA learning cycles. Another added advantage of this implementation approach is that data collection is essential to the process of change, helping the organization see the value of research as an inherent activity for capacity building.

The research team becomes a partner and an asset for organizational development rather than one more outside force to contend with when trying to make decisions.