Organizing for collaboration: An actor-oriented architecture in ImproveCareNow

Learn Health Syst. 2019 Nov 13;4(1):e10205. doi: 10.1002/lrh2.10205. eCollection 2020.


Background: Collaborative learning health systems (CLHSs) enable patients, clinicians, researchers, and others to collaborate at scale to improve outcomes and generate new knowledge. An organizational framework to facilitate this collaboration is the actor-oriented architecture, composed of (a) actors (people, organizations, and databases) with the values and abilities to self-organize; (b) a commons where they create and share resources; and (c) structures, protocols, and processes that facilitate multiactor collaboration. CLHSs may implement a variety of changes to strengthen the actor-oriented architecture and enable more actors to create and share resources.

Objective: To describe and measure implementation of elements of the actor-oriented architecture in an existing Collaborative Learning Health System.

Methods: We used the case of ImproveCareNow, a CLHS improving outcomes in pediatric inflammatory bowel disease, founded in 2006. We traced several network-level indicators of actor-oriented architecture between 2010 and 2016.

Results: We identified measures of actors, the commons, and ways that have made it easier for network member sites to participate. These indicators show ImproveCareNow has made changes in the three elements of the actor-oriented architecture over time.

Conclusion: It is possible to measure the implementation of an actor-oriented architecture in a CLHS. The elements of the actor-oriented architecture may provide a conceptual framework for their development and optimization. Metrics such as those described here may be actionable indicators of the "health of the system."

Keywords: chronic care; collaborative learning health systems; organizational theory.