The learning health system: An R and D department for local solutions

From Apple to Toyota to McDonalds, major companies spend billions on research and development. R&D teams explore technologies, test products and survey customers about services. So what about health care?

For the most part, health-care organizations don’t have R&D departments. Typically, researchers at health organizations apply for grants for a one-off study, but there’s not a steady stream of R&D funding, nor a strategic, leadership-driven approach to research.

That’s a problem. As Noah Ivers, a family doctor and researcher at Women’s College Hospital, puts it, “a corporation that is doing research and development doesn’t give a pocket of money for a short amount of time, and then tell the team to disband, and start again, which is basically how health systems research works right now.”

A health-care R&D department could invest in long-term data gathering and analysis and look at where a major health-care organization is falling short. It could find solutions to address shortcomings and monitor progress over many years.

Fortunately, examples of this are emerging. In Mississauga, the Institute for Better Health (IBH), launched in 2014, works much like an R&D department – clinical leaders at Trillium Health Partners directly engage IBH’s researchers day to day to help them meet health delivery objectives.

In Vancouver, there’s the Vancouver Coastal Health Research Institute, the research arm of Vancouver Coastal Health, a health partner of the University of British Columbia and one of Canada’s top-funded research organizations.

Toronto’s Centre for AI Research and Development is another example – though housed  at the University of Toronto, rather than a hospital, the centre works with hospitals to test and implement new technologies that it can measure and perfect over the long term.

Taking an R&D approach means recognizing that research involves “sunk costs,” says Rob Reid, chief scientist at the IBH and senior vice-president of science at Trillium Health Partners. Research grants fund people to research one project for a fixed amount of time but an R&D approach of steady funding is needed too, says Reid, to get ideas off the ground, connect various research projects and continue improving upon projects even after grants run out.

Researchers in an R&D department for a major health-care organization can get to know the administrators and front-line health workers, get a sense of the culture and learn the best techniques for changing practices. By working with an organization over the years, the researchers have that “institutional knowledge” of what’s been attempted and what’s worked, what hasn’t and why.

They can also shape how an organization collects data. When Trillium implemented its electronic medical record across its entire system, “we had a lot of say in terms of how the data was going to be collected,” says Reid. For example, IBH provided guidance on what socioeconomic information patients would be asked to provide and how socioeconomic categories would be defined. That way, the institute can ensure the categories are clear enough that researchers can determine where the system is providing equitable care and where it can do better.

In an R&D approach, it is the health-system leaders who decide which programs are important rather than granting agencies taking the lead. At the R&D department of Kaiser Permanente Washington, called the Learning Health System Program, the core team of five researchers meets with clinical leaders every year to come up with six or seven research projects aligned with strategic objectives.

Paula Lozano, Medical Director, Research and Translation at Kaiser Permanente Washington, says she pushed for the R&D approach because “it felt like we were doing all this amazing research. And some of it would yield findings that were very promising. And yet we were failing to fully implement the research in our own health system.”

Rather than doing “research for research’s sake,” says Lozano, researchers at the LHS Program want to solve the problems that “keep the leaders of the organization up at night.” Throughout the year, clinicians engage the department when they need data. When COVID hit, for example, front-line clinicians asked the team to analyze patient data and identify who clinicians should be reaching out to – “who needed refills on their medications and who actually needed to come in and be seen,” says Lozano. That’s not research that’s going to be published in JAMA, but it’s research that’s going to have immediate benefits on hundreds of people, for a relatively small input.

With a conventional approach, an intervention would be tried in one site and the results of that trial published so it could be adopted elsewhere. But solutions to most health-care problems need to be tested and tailored locally, says Reid. “With the pandemic, the problems we see in Mississauga are not the same problems that we’re seeing in Muskoka.”

R&D departments – where study funding, technology and resources are “embedded and entwined” with health-care delivery – “can evolve the system the way Amazon would, or even an NFL or NBA team would or an airline would.” says Reid. “It’s about developing the infrastructure for rapid cycle change.”

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1 Comment
  • Douglas Wright says:

    Good day excellent points. Examples abound at Scigiene we are leading scientific instrument suppliers and the leading supplier for Hygiene monitoring systems and have been involved in numerous studies that have proven that increased use of ATP hygiene in monitoring vastly reduces H.A.I. rates. One study showed a massive 50% drop. The staff wanted to share the data but senior management would not permit it. There is too much petty rivalry among sr. managers. To be fair sometimes its the lawyers or even the unions so just getting studies published requires vast resources. The hurdles to sharing the data need to be removed.
    You are bothnright and wrong about terminating the studies after they are finished. Using the Hygiene monitoring system studies as examples. We can show clients how to continually improve sanitation and further reduce HAI’s thus saving money (lots of money!) . It does this by allowing staff to engage in site specific studies to show if new training is working, if new sanitizers are effective etc. These sub studies do not need to be ongoing but they should be shared so that other infection control teams can can say “hey lets try that here”.
    The Hygiene study would be ongoing to simply catch slip ups but the studies on the efficay of new methods and equipment would not need to be continued ad infinitum. Instead those resource could be redirected to studying other aspects or actual implementation of the new practices.
    Problem #2 the savings generated here affect numerous departments. But the cost for buying this are usually designated to one department. usually housekeeping or infection control that tend to be the kicking boys when budget cuts come, The whole medical system needs to redo its costing strategy the way a business would. If I buy equipment that benefits my company then we buy it and no one department gets penalized to the benefit of others.
    The bottom line is that I have hundreds of hospitals all conducting the same studies but they rarely get to share those results. That is a waste of resources. If Maple Leaf Foods did a study at one office the Director of QA would share those results with other offices and they would all benefit. The hurdles through which hospital staff would need to jump discourage all but the bravest and to often those get fired or shuffled of to a position where they can “do no harm” just for stepping on toes. Too bad ? We need more folks in the system brave enough to challenge the system from within.


Wendy Glauser


Wendy is a freelance health and science journalist and a former staff reporter with Healthy Debate.


Umayangga Yogalingam


Umayangga is a Toronto-based public health professional with several years of experience in youth health and engagement. She is also a freelance artist who dabbles in acrylic painting, ink illustrations, digital art and more.

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