The goal of a learning healthcare system is to deliver the best care every time, and to learn and improve with each care experience. This goal is attainable only through system-wide changes of the sort that have been successfully undertaken in certain activities of the manufacturing sectors. In these cases significant benefits have been realized through organization-wide transformations guided by principles of systems and process engineering and the practices of structured data feedback for process improvement. Data collection and monitoring are increasingly important components of health care, but much remains to be done in their application for continuous improvement. Engineering sciences associated with system design could contribute to a learning healthcare system that applies the best-known evidence, encourages continuous learning, and allows for knowledge generation as a natural by-product of patient care delivery. A fully functional system of this sort would advance quality; improve patient and provider safety, in turn delivering increasing value to consumers; and ensure that the care that is delivered is centered on the best outcome for each patient.
With these issues in focus, Engineering a Learning Healthcare System: A Look at the Future was organized by the National Academies to take stock of lessons from engineering that might be applicable to health, to investigate examples of efforts completed or under way in that respect, and to examine prospects for increasing the level of interdisciplinary, cooperative activity. The workshop was one of a series of workshops sponsored by the IOM Roundtable on Value & Science-Driven Health Care (then, the Roundtable on Evidence-Based Medicine) and focused on the development of a learning healthcare system. Because the workshop aimed to identify learning opportunities from health care, and teaching opportunities from engineering, it was structured both to review already well-established examples of activities in which engineering principles—in particular, systems engineering—have been adapted for use in healthcare settings, as well as to encourage discussion of additional opportunities and approaches to fostering ongoing progress in communication between the two fields.
An overview of the premises of the workshop identified by the workshop planning committee is found in Box S-1. Throughout the meeting’s discussions, frequent mention was made of the cross-relevance of the concepts, and participants observed that even some of the terminology and reference points were similar—e.g., the discussions of Harold W. Sorenson and William W. Stead who addressed, respectively, how to engage health as a complex system, and approaches to adjusting to a more complex clinical decision environment. Case studies illustrated achievements in health care that have drawn upon systems engineering, and breakout sessions challenged workshop participants to identify opportunities and actions for generating additional value in health care through application of engineering concepts. Neither the case studies nor the breakout sessions yielded