The Swiss Learning Health System (SLHS) is a collaborative project between seven academic partner institutions to establish a national platform for health systems and services research, policy and practice. The goal of the SLHS is to foster dialogue between different stakeholders with the aim of developing and continuously integrating evidence-based solutions to current and future challenges in the health system. The SLHS relies on cyclical dynamics to identify issues, systematize relevant evidence, present alternative actions, select the best action, implement change, observe its consequences and, if necessary, revise and reshape responses.
Introduced in 2017, the SLHS is the first initiative worldwide to systematically introduce the concept of a learning health system on a nation-wide level.
Health care systems worldwide are challenged by changing patterns of communicable and non-communicable diseases, population aging, increasing technological progress and growing resource constraints.
To ensure fitness-for-purpose, effectiveness and efficiency of health systems, decision-making on all levels of the system needs to be supported by the best available evidence. The utilized evidence should relate to high-quality research that addresses health system needs, including the evaluation of expected benefits and costs of different courses of action.
In learning health systems (LHSs), the research agenda is collaboratively developed to be responsive to current health system needs and to facilitate the flow of information at levels of policy, research and practice. By doing so, the LHSs are promoting evidence-based policy making and create continuous learning processes that match health system needs. This in turn creates a culture of shared responsibility, creating a learning environment that links all actors in the health system – patients, health care providers, insurers, researchers and health policy makers – in the common cause to strengthen the health system, improve population health, and to ultimately achieve better value for the money in healthcare.
The Swiss Learning Health System's (SLHS's) goal is to foster the dialogue between different health relevant stakeholders and thus developing and continuously integrating evidence-based solutions to current and future challenges in the healthcare system. In order to achieve the goal of bridging research, policy and practice, the SLHS educates scholars in the specific skills needed in a learning health system and it builds a management tool for standardized health information.
Bridging research, policy and practice
In order to be responsive to current health system needs, the research agenda within the Swiss Learning Health System (SLHS) is developed in strong collaboration with all partners involved. This not only facilitates the seamless flow of information and evidence at the levels of policy, research and practice but it will eventually translate into a continuous learning process that matches the system´s research needs with the appropriate results. In turn a culture of shared responsibility is fostered, creating a learning environment that links all actors in the health system.
As depicted in the graph below, the first step in the learning health system is to identify pressing topics and challenges in the health system, which are defined by the SLHS network and relevant stakeholders. Based on different suggestions a topic list is built which is updated on a regular basis. The topic list forms the basis for the process of issue prioritization.
Once issues have been identified and prioritized, the Operational Unit of the SLHS issues calls for evidence syntheses to which all academic partner institutions can reply and consequently commence with the development of Policy Briefs or Rapid Response Syntheses, which will be distributed to all relevant stakeholders. Whereas policy briefs will be used to inform stakeholders in preparation for the following stakeholder dialogue, rapid response syntheses serve as guiding documents for swift courses of action in cases where response time to current health system needs is limited.
One of the core activities of the SLHS is the organization of Stakeholder Dialogues. Those dialogues aim at bringing together different stakeholders with a vested interest in the topic under discussion. Stakeholder dialogues are a structured communication process that uses a deliberative dialogue during which two or more stakeholders work collaboratively toward a common understanding with the aim to reach agreement on the problem at hand.
The final mechanism of the SLHS monitors the implementation efforts, which are led by the relevant stakeholders. Implementation considerations that were formulated by experts of the SLHS platform either in the evidence syntheses documents or as part of the stakeholder dialogue, will serve as guidance for implementation. The SLHS Operational Unit will support and evaluate implementation efforts. Feedback will be presented back to relevant stakeholders in order to further foster the learning health system cycle.
Scientific capacity building
The SLHS trains research scientists with the ability to understand and conduct high quality research in the intersection of practice, policy and research, which is essential for establishing a successful learning health system.
To this end, the SLHS scientific capacity building program offers short courses by leading international experts in the following areas of expertise:
- Vision of a learning health system
- Health systems and policy
- Evidence-informed policy framework
- Implementation research
- Principles of communication in a LHS
The program is tailored for SLHS PhD students. However, researchers with a high interest in the vision of a learning health system can also be admitted to the short courses.
Management and standardized health information
An important prerequisite for health systems research are standards for the structure and content of data, including structured entry points to existing data sources, as well as the application of appropriate analysis methods of coded patient and health system data. These standards need to be suitable for the collection of new data, as well as the transformation of existing data into a standardized reporting format.
Therefore, the third objective of the SLHS is to develop national data standards for structured reporting and, where appropriate, the collection of new multipurpose health information.