Realizing the Promise of Learning Organizations to Transform Mental Health Care: Telepsychiatry Care As an Exemplar

Learning organizations collect data, interpret them, and feed the information obtained back into their own system to continuously improve their processes. Drawing on the recent work of the National Academy of Medicine (3) and the Agency for Healthcare Research and Quality (https://www.ahrq.gov/learning-health-systems/about.html), learning organizations can “continuously, routinely, and efficiently study and improve themselves” (4). Key features of these organizations are that every patient’s data are available immediately for analysis to support health care decisions. Moreover, these organizations continuously improve processes and provide an infrastructure that involves stakeholders and enables routine and automatic data collection (4).

To date, mental health consortia such as the Mental Health Research Network (5) and National Network of Depression Centers have implemented concepts from the learning organization literature (6). These efforts represent collaborations between large health systems that involve standardized protocols in key initiatives such as suicide prevention and measurement-based care. These are excellent examples of how organizations can come together within a practice-based research network to learn from one another. However, limited empirical information is available about the mechanisms through which learning organizations function. For optimal results, learning and system improvement should ripple through all levels of the organization. Efforts to this end in mental health care have largely leveraged electronic health records (EHRs) and other local data to inform broad improvement initiatives or smaller continuous quality improvement (CQI) efforts. For example, CQI has been used to improve consumer access and engagement by reducing wait times (7). However, this approach is best suited to improving organizational care processes (i.e., at the macro level) rather than to supporting individual clinician change. Particularly when the change requires engagement and behavior change at the level of the clinician, it is likely that this approach alone will be insufficient for transforming care. In contrast, measurement-based care (MBC) may yield quality improvements at the micro level, as it more directly involves the clinician and patient in processes that use clinical data to change procedures (8). MBC allows individual clinicians to track progress in the therapy process and to use that information to decide what changes need to be made for improving the process. However, although complementary and sharing a common goal of using data to inform improvement (8), CQI and MBC are rarely used together.

We propose that the key mechanism of a learning organization is true alignment and empowerment of stakeholders at both the organizational and clinician levels to continuously use the most relevant data at each level—including feedback from consumers—to engender clinical practice and organizational change (see figure in the online supplement) (9).

The concept of learning organizations is largely aspirational in mental health care. Further research that investigates how to implement learning organizations is needed to transform mental health care globally. Below, we operationalize key building blocks of a learning organization in mental health care by using the example of telepsychiatry care, given its relevance in light of the physical distancing required to minimize the spread of COVID-19.

In these unprecedented times, as-we-go learning and rapid adaptation to new practice procedures are needed to face the challenges of the current health crisis. One response to the COVID-19 pandemic has been the rapid implementation of telepsychiatry care, in which the principles and practices of learning organizations are more important than ever. Moving beyond aspirational goals and toward functioning learning organizations in mental health care will require both the technological capacity and the ability of organizational leaders to spark clinician motivation, reflection, and innovation. This move requires a psychologically safe environment that encourages reflection, motivates individuals and teams to quickly learn from data, and uses incentives and rewards effectively. These steps can inspire and celebrate the contributions of clinicians and leaders at all organizational levels to better serve our patients when they need the very best we can offer.