National Academy of Medicine


About the Executive Leadership Network

The Executive Leadership Network for a Continuously Learning Health System (ELN) works to establish the capacity, infrastructure, and culture necessary to drive continuous learning and improvement within and across health care delivery systems by supporting ongoing communication, collaboration, and synergy among executive-level stakeholders with common investments in continuous learning. In addition, ELN participants are a standing group of ad hoc advisors to the National Academy of Medicine on the issues, strategies, and returns from continuous learning capacities that simultaneously support operational decision making, performance improvement efforts, and the generation of better evidence.

  • Related NAM Activities, Discussion Papers, and National Academies Reports

    Clinician Engagement for Continuous Learning

    The 2013 Institute of Medicine report Best Care at Lower Cost: The Path to Continuously Learning Health Care in America laid out a vision for a continuously learning health system, emphasizing the need for science, informatics, patient-clinician partnerships, incentives, and culture to promote real-time improvement in the effectiveness and efficiency of care in the United States.

    A new discussion paper published by the National Academy of Medicine (NAM) builds on this vision and highlights the need for more active engagement of front-line clinicians. The authors contend that actionable, timely, and relevant knowledge generation is best accomplished with fully engaged clinicians, patients, and health care data and that leveraging the insights of front-line clinicians (those who interact with patients the most) is essential to obtaining the best outcomes for clinical practice, and ultimately, for patients. A fully realized learning health system absolutely depends on clinicians’ active participation in learning activities. Download the discussion paper >>

    Harnessing Evidence and Experience to Change Culture: A Guiding Framework for Patient and Family Engaged Care

    Past reports from the National Academy of Medicine (NAM) and others have concluded that the involvement of patients and families is key to the national strategy of realizing a high quality, high value health system that achieves patient-centered outcomes.

    A new discussion paper published by the NAM builds on this concept, and asserts that a cultural shift to “patient and family engaged care” is an essential driver to achieving the “Quadruple Aim” outcomes of better culture, better care, better health, and lower costs. By introducing the term patient and family engaged care, the authors recognize the evolution of the field toward embracing partnership—working with patients and families, not simply doing to and for them. Download the discussion paper >>

    Vital DirectionsVital Directions for Health and Health Care

    More than 5 years after the passage of the Affordable Care Act, health reform is entering a critical new phase. The health system is strained by increasing demand and unsustainable costs. Too often, care decisions do not align with patient goals or evidence of effectiveness, and Americans experience untenable disparities in health and access to care. At the same time, new technologies and big data are spurring advances in medical science and the practice of care, including precision medicine. Patients are increasingly empowered to take an active role in their health, and community innovators are designing new models that could revolutionize the delivery of care. Increasing emphasis is placed on population health, wellness and prevention. These are the unprecedented challenges — and extraordinary opportunities — the incoming presidential administration must weigh as it charts the next steps for health reform in the United States. Read the series >> 

    Vital Signs: Core Metrics for Health and Health Care Progress

    Thousands of measures are in use today to assess health and health care in the United States. Although many of these measures provide useful information, their usefulness in either gauging or guiding performance improvement in health and health care is seriously limited by their sheer number, as well as their lack of consistency, compatibility, reliability, focus, and organization. To achieve better health at lower cost, all stakeholders – including health professionals, payers, policy makers, and members of the public – must be alert to what matters most. What are the core measures that will yield the clearest understanding and focus on better health and well-being for Americans? Learn more about Vital Signs by visiting

    VS Interactive Infographic

    NAM Action Collaborative on Clinician Well-Being and Resilience

    Every year in the United States, about 400 physicians take their own lives — a rate more than double that of the general population. Physicians experience high rates of depression, burnout, and poor work-life balance. This phenomenon cuts across all ages, stages, and career paths — from trainees to senior practitioners. And these challenges are not unique to physicians. Nurses and other clinicians experience similar effects on performance, health, and well-being.

    CR logoThe National Academy of Medicine will build a collaborative platform for supporting and improving clinician well-being and resilience across multiple organizations, including clinician and consumer groups as well as health care organizations and policy making bodies. This “action collaborative” will provide the venue for a set of collaborative activities, grounded in evidence-based knowledge, to (1) assess and understand the underlying causes of clinician burnout and suicide, and (2) advance solutions that reverse the trends in clinician stress, burnout, and suicide. Activities of the collaborative will include working meetings among participating groups, public workshops, and stakeholder engagement activities. Learn more about the initiative >>

    Observations from the Field: Reporting Quality Metrics in Health Care

    Measurement is a critical tool for monitoring progress and driving improvement in health care. However, without meaningful coordination and management—particularly when public reporting is required—the effectiveness of measurement activities is limited and the diversion of effort from other activities can be detrimental to an organization. Often, the metrics used in quality reporting are derived from billing and administrative systems. Concentrating on improving these metrics may siphon energy from more meaningful or clinically relevant improvements. Too many measures can blur the focus on an institution’s priority issues while crowding out resources in terms of time, staffing, and money needed for innovation and improvement. Read the discussion paper >> 

    Transforming Health Care Scheduling and Access: Getting to Now

    tarnforming health care scheduling and access-getting to nowLong waits for treatment are a function of the disjointed manner in which most health systems have evolved to accommodate the needs and the desires of doctors and administrators, rather than those of patients. The result is a health care system that deploys its most valuable resource–highly trained personnel–inefficiently, leading to an unnecessary imbalance between the demand for appointments and the supply of open appointments. Download the Report >> 

    Generating Knowledge from Best Care: Advancing the Continuously Learning Health System

    In this discussion paper, the authors aim to facilitate the growth of learning health environments by highlighting strategies and examples of operational and research collaborations within delivery system settings in the United States. It is the authors’ intention that this paper will add to the emerging body of knowledge around learning health systems while also serving as an actionable blueprint for institutions interested in transforming to a continuously learning system. Read the discussion paper >> 

    Data Acquisition, Curation, and Use For a Continuously Learning Health System: A Vital Direction for Health and Health Care

    Increased sharing of health data among all stakeholders in the health system—from patients and advocates to health professionals and medical researchers—is essential for creating a learning health system. Such a system would leverage health data from a variety of sources to meet the challenges of increasingly complex medical decisions and, in the process, create knowledge more efficiently in the service of producing better patient outcomes and less waste. Read the discussion paper >>


    Integrating Research and Practice: Health System Leaders Working Toward High-Value Care

    Health care has been called one of the most complex sectors of the U.S. economy. Driven largely by robust innovation in treatments and interventions, this complexity has created an increased need for evidence about what works best for whom in order to inform decisions that lead to safe, efficient, effective, and affordable care. As health care becomes more digital, clinical datasets are becoming larger and more numerous. By realizing the potential of knowledge generation that is more closely integrated with the practice of care, it should be possible not only to produce more usable evidence to inform decisions, but also to increase the efficiency and decrease the costs of doing clinical research. Download the Report >>

    Essential Stewardship Priorities for Academic Health Systems

    In “Essential Stewardship Priorities for Academic Health Systems,” the CEOs of five leading academic centers – BJC HealthCare, Duke University Medical Center, Henry Ford Health System, Partners HealthCare System, and UCLA Health System draw from experiences built on the unique strengths and roles of their institutions to develop the ten essential priorities for Academic Health Systems in navigating the evolving health care terrain. Read the discussion paper >>

    Observational Studies in a Learning Health System: Workshop Summary 

    Clinical research strains to keep up with the rapid and iterative evolution of medical interventions, clinical practice innovation, and the increasing demand for information on the clinical effectiveness of these advancements. In response to the growing availability of archived and real-time digital health data and the opportunities this data provides for research, as well as the increasing number of studies using prospectively collected clinical data, the National Academy of Medicine’s Leadership Consortium for a Value and Science-Drive Health System convened a workshop on Observational Studies in a Learning Health System. Download the meeting summary >> 

    Large Simple Trials and Knowledge Generation in the Learning Health System: Workshop Summary

    Randomized clinical trials (RCTs) are often referred to as the “gold standard” of clinical research. However, in its current state, the U.S. clinical trials enterprise faces substantial challenges to the efficient and effective conduct of research. Streamlined approaches to RCTs, such as large simple trials (LSTs), may provide opportunities for progress on these challenges. Clinical trials support the development of new medical products and the evaluation of existing products by generating knowledge about safety and efficacy in pre- and post-marketing settings and serve to inform medical decision making and medical product development. Download the workshop summary >> 

    Best Care at Lower Costs: The Path to Continuously Learning Health Care in America

    America’s health care system has become too complex and costly to continue business as usual. Best Care at Lower Cost explains that inefficiencies, an overwhelming amount of data, and other economic and quality barriers hinder progress in improving health and threaten the nation’s economic stability and global competitiveness. According to this report, the knowledge and tools exist to put the health system on the right course to achieve continuous improvement and better quality care at a lower cost. Download the report >>

    Digital Infrastructure for the Learning Health System: The Foundation for Continuous Improvement in Health and Health Care: Workshop Series Summary

    digital indrastructure for a learning health systemLike many other industries, health care is increasingly turning to digital information and the use of electronic resources. The Leadership Consortium for a Value and Science-Driven Health System hosted three workshops to explore current efforts and opportunities to accelerate progress in improving health and health care with information technology systems. Read  the summary >>

    Leadership Commitments to Improve Value in Health Care:  Finding Common Ground: Workshop Summary

    This volume reports on discussions among multiple stakeholders about ways they might help transform health care in the United States. The U.S. healthcare system consists of a complex network of decentralized and loosely associated organizations, services, relationships, and participants. Each of the healthcare system’s component sectors–patients, healthcare professionals, healthcare delivery organizations, healthcare product developers, clinical investigators and evaluators, regulators, insurers, employers and employees, and individuals involved in information technology–conducts activities that support a common goal: to improve patient health and wellbeing. Implicit in this goal is the commitment of each stakeholder group to contribute to the evidence base for health care, that is, to assist with the development and application of information about the efficacy, safety, effectiveness, value, and appropriateness of the health care delivered. Read the summary >>

    Clinical Data as the Basic Staple of Health Learning: Creating and Protecting a Public Good: Workshop Summary

    Successful development of clinical data as an engine for knowledge generation has the potential to transform health and health care in America. As part of its Learning Health System Series, the Leadership Consortium for a Value & Science-Driven Health System hosted a workshop to discuss expanding the access to and use of clinical data as a foundation for care improvement. Download the workshop summary >> 

    Redesigning the Clinical Effectiveness Research Paradigm: Innovation and Practice-Based Approaches: Workshop Summary

    Recent scientific and technological advances have accelerated our understanding of the causes of disease development and progression, and resulted in innovative treatments and therapies. Ongoing work to elucidate the effects of individual genetic variation on patient outcomes suggests the rapid pace of discovery in the biomedical sciences will only accelerate. Download the workshop summary >> 

    Initial National Priorities for Comparative Effectiveness Research

    Clinical research presents health care providers with information on the natural history and clinical presentations of disease as well as diagnostic and treatment options. In today’s healthcare system, patients, physicians, clinicians and family caregivers often lack the sufficient scientific data and evidence they need to determine the best course of treatment for the patients’ medical conditions. Download the report >> 

    Accelerating Medical Evidence Generation and Use

    This series of meetings underscored the importance of partnerships between researchers and health system leadership and considered opportunities to build institutional capacity, cross-institutional synergy, and system-wide learning. The vision is digital system-wide progress toward continuous and seamless learning and improvement throughout health and health care. Download the Special Publication>>

  • Members of the Executive Leadership Network

    • Adeptus Health, Inc.
    • Advocate Health Care
    • Ascension Health
    • Baylor Scott & White Health
    • Banner Health
    • Baylor Scott & White Health
    • Bellin Health
    • BJC HealthCare
    • Blue Cross Blue Shield Association
    • Bon Secours Health System, Inc.
    • Boston Children’s Hospital
    • Boston Medical Center
    • Carolinas HealthCare System
    • Brigham & Women’s Health Care
    • Catholic Health Association
    • Chicago Community Trust
    • Children’s Hospital Los Angeles
    • Children’s Mercy Hospital
    • Children’s Hospital of Philadelphia
    • Christiana Care Health System
    • Cincinnati Children’s Hospital Medical Center
    • Cleveland Clinic
    • Clinical Directors Network, Inc.
    • Community Health Systems
    • CVS Health
    • Dartmouth-Hitchcock Medical Center
    • DaVita HealthCare Partners
    • Denver Health
    • Dignity Health
    • Duke University Health System
    • Eskenazi Health
    • Fairview Health Services
    • Greenway Health
    • Froedtert Health System
    • Grady Health System
    • Group Health Cooperative
    • Health Share of Oregon
    • HealthPartners, Inc.
    • HealthSouth Corporation
    • Indian Health Service, U.S. Department of Health and Human Services
    • Intermountain Healthcare, Inc.
    • Henry Ford Health System
    • Hospital Corporation of America
    • Kaiser Permanente
    • Kaiser Permanente
    • LifePoint Health
    • Lifespan and Rhode Island Hospital
    • Louisiana State University Health Care Services Division
    • Marshfield Clinic Health System
    • Massachusetts General Physicians Organization
    • Mayo Clinic
    • Mayo Clinic, Arizona
    • MD Anderson Cancer Center
    • Medical College of Wisconsin
    • Mercy Health
    • Molina Healthcare
    • Montefiore Medical Center
    • Morehouse School of Medicine
    • Mount Sinai Health System
    • National Institutes of Health Clinical Center
    • Nationwide Children’s Hospital
    • Nemours Foundation
    • New York City Health and Hospitals Corporation
    • New York University Langone Medical Center
    • NewYork-Presbyterian Hospital
    • Northwell Health
    • NorthShore University HealthSystem
    • Palo Alto Medical Foundation
    • OCHIN
    • Ochsner Health System
    • Press Ganey Associates, Inc.
    • Providence Health and Services
    • Scripps Health
    • Sutter Health
    • Seattle Children’s Hospital
    • St. Louis Children’s Hospital
    • ThedaCare
    • Tulane University Health System
    • U.S. Department of Defense
    • University Hospital
    • University of Alabama Birmingham
    • University of California, Irvine Medical Center
    • University of Alabama Birmingham
    • University of Arizona Banner University Medical Center
    • University of California, Los Angeles Health
    • University of California, San Diego Health Sciences
    • University of California, San Fancisco Medical Center
    • University of Chicago Medical Center
    • University of Nebraska Medical Center
    • University of Colorado Health
    • University of Iowa Hospitals and Clinics
    • University of North Carolina Health Care System
    • University of Pittsburgh Medical Center
    • University of Texas Health Science Center at San Antonio
    • University of Texas Medicine San Antonio
    • University of Wisconsin Health
    • University of Texas Southwestern Medical Center
    • University of Virginia Medical Center
    • Vanderbilt Health System
    • Vidant Healthcare



Learn more about the Leadership Consortium for a Value and Science-Driven Health System >>