Learning Health System Research Competency Framework

Competencies

The MN-LHS Program will allow scholars to develop Learning Health System Research Core Competencies.

Learning Health System

A system in which science, informatics, incentives, and culture are aligned for continuous improvement and innovation, with best practices seamlessly embedded in the care process, patients and families active participants in all elements, and new knowledge captured as an integral by-product of the care experience.

Learning Health System Researcher Definition

An individual who is embedded within a health system and collaborates with its stakeholders to produce novel insights and evidence that can be rapidly implemented to improve the outcomes of individuals and populations and health system performance.

By embedded we mean that the researcher is part of the system when conducting the research, either as an employee or as an invited guest who assists with the development, conduct, implementation, and dissemination of research.

Health systems refer to one or more organizations and individuals that interact to restore or promote individual and population health.

Stakeholders are patients, caregivers, clinicians, system leaders, improvement specialists, and other individuals who interact to carry out the functions of the health system.

The word “rapidly” is used to connote the need in LHS research to ensure.

Competency Domains

Competency Domain 1: Systems Science

Domain Definition

To understand how health systems operate and how to apply systems theory to research and implementation.

Competencies

1.1: Demonstrate knowledge of how systems theories can be used to understand how the interactions of the parts of health systems operate to produce value for stakeholders.
1.2: Demonstrate systems thinking in the design and conduct of research and implementation of its findings within the context of complex health systems.
1.3: Demonstrate knowledge of the financing, organization, delivery, and outcomes of health care services and their interrelationships.
1.4: Demonstrate the ability to assess the extent to which research activities will likely contribute to the quality, equity, or value of health systems.

Competency Domain 2: Research Questions and Standards of Scientific Evidence

Domain Definition

To ask meaningful questions and evaluate the usefulness of scientific evidence and insights.

Competencies

2.1: Demonstrate the ability to compose feasible and timely research questions and hypotheses, incorporating stakeholder priorities, to generate evidence that informs meaningful clinical and policy decisions.
2.2: Demonstrate the ability to engage with all relevant stakeholders (patients, families, clinicians, and system leaders) in the elicitation and prioritization of research questions that address current and future stakeholder needs.
2.3: Demonstrate the ability to critically analyze and assess available scientific evidence from peer- reviewed articles, systematic reviews, meta-analyses, and gray literature to identify novel LHS questions and to judge the applicability of the evidence to a local care setting.

Competency Domain 3: Research Methods

Domain Definition

To conduct research within the context of complex health systems using appropriate study designs and analytic methods to assess outcomes of interest to health systems stakeholders.

Competencies

3.1: Demonstrate the ability to use theory and conceptual models in the design and interpretation of LHS research.
3.2: Demonstrate the ability to develop an appropriate observational, quasi-experimental, or experimental study design while mitigating threats to internal and external validity for research that is minimally disruptive to operations in real world health systems and practices.
3.3: Demonstrate knowledge of mixed methods and how they can be used to improve LHS research studies.
3.4: Demonstrate knowledge of how to assess multilevel determinants of health and health care disparities when designing studies.
3.5: Demonstrate the ability to select and interpret appropriate clinical, financial, and patient-centered outcomes of interest based on the concepts they measure and their measurement properties.
3.6: Demonstrate the ability to apply the principles of hypothesis testing and statistical inference to data collected routinely through the course of care as well as supplemental data from patients, providers, and health systems.

Competency Domain 4: Informatics

Domain Definition

To know how to use information systems to conduct LHS research and improve patient and health system outcomes.

Competencies

4.1: Demonstrate the ability to use data derived from electronic health records and other clinical information sources for research and quality improvement.
4.2: Demonstrate knowledge about additional data sources that can be linked to health system clinical data in order to augment exposure and outcome ascertainment.
4.3: Demonstrate the ability to assess data quality and apply data quality assurance processes, including error prevention, data cleaning, data monitoring, documentation, and relevant data standards.
4.4: Demonstrate knowledge of population health informatics, including disease surveillance, monitoring of community health, assessment of social and behavioral determinants of health, and geographic information systems.
4.5: Demonstrate knowledge of clinical information systems, including electronic health records, clinical documentation, computerized physician order entry (CPOE), clinical decision support systems, electronic prescribing, medical imaging, and clinical/population dashboards.

Competency Domain 5: Ethics of Research and Implementation in Health Systems

Domain Definition

To ensure that research and quality improvement done in health care settings adheres to the highest ethical standards.

Competencies

5.1: Demonstrate the ability to apply ethical principles in the engagement of health systems, including issues of business ethics and the importance of publishing both positive and negative findings in the public domain.
5.2: Demonstrate knowledge of what activities constitute research as opposed to quality improvement activities, and seek appropriate oversight for each.
5.3: Demonstrate knowledge of specific Health Insurance Portability and Accountability Act (HIPAA) requirements associated with varied data sources used in health systems research activities and seek appropriate approvals.
5.4: Demonstrate the ability to identify and minimize potential conflicts of interest in the design, conduct, and reporting of research conducted in health systems.
5.5: Demonstrate knowledge of ethical and legal considerations when engaging in multi-system studies for compliant collaboration and study conduct.

Competency Domain 6: Improvement and Implementation Science

Domain Definition

To reduce avoidable variation in process and outcomes and ensure the systematic uptake of research findings in a health system.

Competencies

6.1: Demonstrate the ability to employ specific quality improvement methods to reduce avoidable variation in clinical processes and outcomes in routine practice.
6.2: Demonstrate the ability to employ specific implementation science or quality improvement methods to study and promote systematic uptake of research findings and other effective clinical interventions into routine practice.
6.3: Demonstrate knowledge regarding when to mount larger efforts to scale up, spread, and sustain successful interventions based on strength of clinical evidence and organizational and provider readiness to change and adopt interventions.

Competency Domain 7: Engagement, Leadership, and Research Management

Domain Definition

To engage stakeholders in all aspects of the research process and effectively lead and manage LHS research teams and projects.

Competencies

7.1: Demonstrate the ability to build and lead research teams with diverse health system stakeholder representation.
7.2: Demonstrate knowledge of the values and communication mechanisms used by stakeholder groups involved in research in health systems.
7.3: Demonstrate the ability to translate, disseminate, and communicate the value proposition and business case for research to diverse health system stakeholders.
7.4: Demonstrate the ability to conduct effective team-based project management, employing skills in leadership, communication, negotiation, consensus building, and problem-solving.
7.5: Demonstrate the ability to develop protocols consistent with health systems needs and timelines, employing patient and clinician engagement, and using a mix of conventional and alternative funding sources.
7.6: Demonstrate the ability to implement protocols aligned with health systems operations and integrated into clinical settings, including engaging clinicians in the research process.
7.7: Demonstrate knowledge of participatory research approaches that foster participation and engagement of vulnerable populations.

Competency Domain 8: Equity and Social Justice

Domain Definition

To know how to assess health equity and apply LHS science methods to advance equity and justice in healthcare delivery systems and health.

Competencies

8.1: Assess how existing health inequities affect population-level health, individual health, and healthcare delivery systems with methods grounded in an awareness of the multilevel factors contributing to such inequities.
8.2: Apply methods to optimally engage diverse participants (including clinicians, staff, patients, community members, and caregivers) in LHS initiatives throughout each initiative, from priority-setting to design to implementation through evaluation.
8.3: Demonstrate awareness of the value and limitations of sub-group analyses in LHS research and improvement activities to understand heterogeneity of health system effectiveness.
8.4: Apply LHS knowledge and methods to translate, implement, and scale research innovations to advance equity and justice in health and healthcare delivery.
8.5: Demonstrate awareness of measurement tools related to health equity at the population, community, healthcare practitioner, and individual patient and community member levels.

Competency Domain 9: Hidden Curriculum

Domain Definition

To identify and leverage hidden curriculum needed for a successful LHS career for oneself or for future mentees.

Competencies

9.1: Describe how differences in background may shape experience and outlook for researchers or participants.
9.2: Describe how network gap, culture gap, and bias may each impact experiences in research.
9.3: Describe methods to develop and maintain bidirectional trusting relationships.
9.4: Develop personalized tools to build confidence and identify when such tools may be needed.
9.5: Describe best practices for building allies and facing bias.
9.6: Develop tools to identify and overcome personal and professional setbacks.

Comptency Domain 10: Clinician and Researcher Wellbeing

Domain Definition

To ensure clinician and researcher wellness (in this case, prevention of burnout and moral Injury) is promoted in clinical practice and academic endeavors.

Competencies

10.1: Demonstrate knowledge of concepts/components of burnout and moral injury and possible individual and systems modes of intervention and how to address work climates to become more ethical.
10.2: Demonstrate knowledge of new and accepted methods for recognizing or assessing/measuring burnout and moral injury while explicitly addressing equity as a component.
10.3: Develop tools and/or practices to assess burnout and/or moral injury in team/organization, using standard metrics or methods.
10.4: Develop personal, team, and/or organizational routines, practices, and/or policies to counteract or respond to burnout and moral injury.
10.5: Demonstrate ability to build measures, intervention or study design features intended to measure or address burnout and moral injury into research projects.
10.6: Plan, develop, and implement systems or process changes to embed burnout/moral injury prevention into an LHS to benefit researchers, HCWs, and patients.