A well-oiled machine: the learning health system
By Kim Barnhardt
Like an engineer skilled in adjusting complex machinery to deliver the right product efficiently, John Lavis is focused is on helping strengthen Ontario’s health system to adapt to challenges and deliver health care efficiently.
Dr. Lavis is a champion of the Learning Health System (LHS), an approach that combines research and health care delivery in real-time to improve health and patient and provider experiences while keeping per capita costs manageable.
The Learning Health System framework describes the different components as gears (see graphic above) which all work together in harmony to inform and improve the health system like the components of a smoothly running engine. Analytics and population insights (Gear 1), evidence syntheses (Gear 2), patient, caregiver and co-provider co-design (Gear 3), implementation and reach (Gear 4) and rapid evaluation, feedback and adaption (Gear 5) operate as gears to improve outcomes in the system.
Building on the success of the Learning Health System “nano” courses offered through OSSU to clinician scientists, researchers, citizen scientists and patient partners, he and his colleagues have set their sights on a key group: senior public servants in Ontario’s Ministry of Health and Ministry of Long-Term Care. Based on these popular courses offered several times a year, Dr. Lavis and his colleagues have developed a more targeted 60-minute ‘pico’ version for busy decision-makers. Pico was chosen because it conveys that this new course is even more focused than the nano course, albeit not a 1000 times smaller.
“A learning health system isn’t just great data and analytics, it’s not just gear 2 or 3 which is where evidence from elsewhere and the lived experiences of citizens comes in, it’s not just good with gear 4 or 5, but it puts them all together,” said Dr. Lavis, a professor at McMaster University and founder and director of the McMaster Health Forum. “We are trying to do this with practical examples for decision makers. We talk about what this looks like on the ground, how the gears come together, what assets have they and others already paid for that be aligned in support of this approach.”
With support from OSSU, they have kept together their original delivery team with a citizen partner, Maureen Smith, and research leader Dr. Robert Reid, Chief Scientist Emeritus at Trillium Health Partners. They have also expanded the team to include Dr. Heather Bullock, who has worked in leadership roles in many parts of the health system, including at Waypoint Centre for Mental Health Care. To pique the attention of attendees and make content relatable, they lead with examples from Ontario, and highlight teams doing LHS work that usually encompasses 1 or 2 gears and discuss how they could do more by bringing into play the missing gears.
OSSU also supports the Learning Health System working group that brings together all the key players across Ontario and which built the framework, led by Dr. Reid from the Institute for Better Health at Trillium Health Partners. The framework won the 2025 Canadian Association for Health Services and Policy Research (CAHSPR) award for the best article, Actioning the Learning Health System: An applied framework for integrating research into health systems.
This work will not only benefit Ontario, but other provinces too. Drs. Lavis and Reid have presented a generic framework that anyone can use in Nova Scotia, Newfoundland and Labrador, Saskatchewan, and British Columbia, and soon they will take it to Manitoba. The goal is to help people identify gaps, align existing assets in their provinces and envision what can happen when all health system gears function in unison.
“We are trying to get people to see they need all the gears functioning for a learning health system to work.”
What’s next? A follow up session for the Ontario ministries then a session for hospital, home care and other senior executives who are trying to make sense of how their work could be catalyzed with this approach.
Dr. Lavis’ vision is to spread this mindset into the whole health system, with learning and continuous improvement integrated in real time to equitably improve outcomes.