Abstract for: Organizational Learning in Learning Health Systems: Intervention and Theory Development

Learning Health Systems (LHS) represent a mature concept influencing healthcare organizational strategy, yet conceptual frameworks rarely address behavior, causal interactions, or formal theories of organizational learning. We bridge this gap through a three-stage mixed-methods approach developing a process theory of organizational learning in healthcare. First, we conducted a synthesis from literature (n=4690) identifying "systems-rich" articles and using Rigorously Interpreted Quotation analysis (n=35 articles) to synthesize causal relationships. Second, we formalized these relationships into a causal loop diagram and simulation model validated by LHS experts. Finally, we developed and piloted an assessment toolkit with eight healthcare delivery systems. Our model reveals how healthcare organizations integrate three siloed learning processes—Quality Improvement, Informatics, and Research—creating reinforcing "LHS momentum" loops alongside balancing improvement loops. The resulting assessment toolkit includes an interactive simulation environment, a detailed causal loop diagram with supporting evidence, and comprehensive documentation. Initial piloting demonstrates the model's utility in supporting strategic decision-making across established, developing, and prospective LHS organizations. This work advances organizational learning theory by illuminating path dependence dynamics and oscillation patterns in improvement efforts while translating systems thinking into healthcare contexts that have historically relied on linear conceptualizations of learning.