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Article Discusses Necessity of Learning Healthcare System Core Competencies to Retain and Empower VA Healthcare Workforce

Healthcare is becoming increasingly consumer-driven with wide variation in access to, sources of, and trust in health information, which has been especially pronounced during the COVID-19 pandemic. In 2018, the National Academy of Medicine’s Future of Health Services Report strongly emphasized that research and clinical practice should focus on addressing the complex, multi-level problems facing healthcare systems to improve quality, promote health equity, and make a public health impact. Many of these recommendations called for the adoption of a Learning Health System (LHS) – the process of using data to continuously identify and solve real-world problems facing organizations through advances in informatics, socio-technical and human factors system design, and implementation science. This article describes current LHS-focused educational and competency-building initiatives in VA. The authors also explain VA’s LHS training ecosystem and core competencies, and discuss how it fits within the larger context of VA LHS research and practice, as well as lessons learned.

VA-focused LHS educational programs include: data-to-knowledge initiatives in health sciences and analytics, e.g., OAA/HSR&D health services and informatics research fellowships; knowledge-to-performance opportunities in implementation and quality improvement, e.g., QUERI Learning Hubs and VA’s Innovation Ecosystem’s (IE) Diffusion of Excellence Initiative; and performance-to-data embedded opportunities, e.g., IE’s entrepreneur fellowship programs, QUERI’s Advancing Diversity in Implementation Leadership (ADIL). There are several strengths to the VA LHS training ecosystem: 1) It uses learning communities with strong clinical and research infrastructures actively involved in innovation and quality improvement; 2) Some programs, such as QUERI’s ADIL, are open to employees without a terminal degree, thereby enabling greater diversity and growth; and 3) It focuses on real-world learning opportunities through active engagement across multiple audiences. Ultimately, the VA LHS training ecosystem informs a pragmatic and sustainable roadmap towards improving healthcare research use and can serve as a model for similar efforts within other organizations.


  • There is an urgent need to expand training opportunities in Learning Healthcare Systems, especially as healthcare is increasingly driven by multiple interested parties, impacted by persistent health disparities exacerbated by emerging public health threats, and rapid technology growth. With the ongoing alignment of research and clinical goals, foundational support through research funding, underlying clinical operations infrastructures, and active engagement of interested parties, VA’s LHS training ecosystem promotes a more LHS-savvy, 21st century workforce.

Dr. Kilbourne is Director of VA/HSR&D’s Quality Enhancement Research Initiative (QUERI). Dr. Schmidt is Associate Director of VA’s Advanced Fellowship Program, Office of Academic Affiliations (OAA). Dr. Vega is Chief Officer, VA Office of Healthcare Innovation and Learning (OHIL). Dr. Bowersox leads QUERI’s Center for Evaluation and Implementation Resources (CEIR). And Dr. Atkins is Director of HSR&D.

Kilbourne A, Schmidt J, Edmunds M, Vega R, Bowersox N, and Atkins D. How the VA is Training the Next-Generation Workforce for Learning Health Systems. Learning Health Systems. August 16, 2022; online ahead of print.

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HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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