Prompted by a persistent mismatch between high health expenditures and shortfalls in safety, quality, and health outcomes in the United States, the National Academy of Medicine (NAM) has been shepherding progress over the last two decades toward the vision for a Learning Health System (LHS). A learning health system is one in which science, informatics, incentives, and culture are aligned for continuous improvement, innovation, and equity—with best practices and discovery seamlessly embedded in the delivery process, individuals and families as active participants in all elements, and new knowledge generated as an integral by-product of the delivery experience. Considering the revolutionary capacities afforded by new technologies, from expansive health databases to AI-enhanced tools, the opportunities are unprecedented for advancing toward a continuously learning health system.
Shared Commitments for Health and Health Care: A Trust Framework from the Learning Health System, a new NAM Perspectives Commentary, offers a paradigm for rethinking and renewing bedrock commitments for health stakeholders and strengthening the trust fabric underpinning health care. The paper outlines 10 Shared Commitments that serve as a trust framework to unify expectations among organizational leaders and clients alike—one that can guide health sector reference points and help foster progress against the challenges of system fragmentation and misplaced incentives that result in mistrust.
“The stewardship of the Learning Health System is one of the National Academy of Medicine’s signature contributions,” said NAM president Victor J. Dzau. “This paper is a culmination of nearly two decades of work at the NAM and an incredibly important development to the future of health care in our nation.”
The Shared Commitments represent a mutually reinforcing set of priorities for all health and health care stakeholders and features expected by recipients of health and health care services. Developed and supported through the systematic assessments in the NAM’s Learning Health System Series, the Shared Commitments provide common ground and cause to align systems and minimize fragmentation. Organizations can use the framework to underscore their values and expectations, and to tailor their operations to accelerate progress and discovery. The Shared Commitments are intended to be adaptable reference points for any health sector stakeholder seeking to be a learning and leading organization.
| ENGAGED | Gives primacy to understanding, caring, and acting on people’s goals |
| SAFE | Deploys verified protocols to safeguard against risk from unintended harm |
| EFFECTIVE | Applies continuously updated evidence to target goal achievement |
| EQUITABLE | Advances parity in individual opportunity to reach full health potential |
| EFFICIENT | Delivers optimal outcomes and affordability for accessible resources |
| ACCESSIBLE | Provides timely, convenient, interoperable, and affordable services |
| ACCOUNTABLE | Identifies clear responsibilities, measures that matter, and reliable feedback |
| TRANSPARENT | Displays full clarity and sharing in activities, processes, results, and reports |
| SECURE | Embeds safeguards in access, sharing, and use of data and digital/AI tools |
| ADAPTIVE | Centers continuous learning and improvement in organizational practices |
“The nation has too long endured care that is fragmented, unaffordable, and inequitable. With the knowledge and technologic advances at hand, the time for change is now. Our systems of health and health care are currently insufficient to transform health outcomes, ensure equity, and lower the astounding cost of care,” said Michael McGinnis, NAM Executive Officer and Executive Director of the NAM Leadership Consortium. “We hope the Shared Commitments will serve both as a call for change and as a playbook for health systems across the nation to guide health system alignment, strength, and trust.”
The paper also identifies 12 anchor features aligned to the four foundational elements of a learning health system that can be leveraged alongside operational and clinical leadership so that organizations can:
- Generate and use evidence through intelligent, rigorous learning architecture;
- Ensure that information systems are interoperable, secure, and accessible at the point of need;
- Reward improved outcomes, reduced costs, and deep engagement by both the workforce and the recipients of care; and
- Promote and reinforce an openness to learning, inclusivity, and connection to the individuals and communities served.
The NAM is continuing to build on the deep evidence base to advance priorities for greater spread and scale of the LHS, anchored by a strategy group of leading health organizations.
The views presented in this commentary – Shared Commitments for Health and Health Care: A Trust Framework from the Learning Health System – are those of the authors and do not represent formal consensus positions of the NAM; the National Academies of Sciences, Engineering, and Medicine; or the authors’ organizations.
Learn more and read the commentary at https://nam.edu/shared-commitments-for-health-and-health-care-a-trust-framework-from-the-learning-health-system.
