3.3 Anticipating and responding to change: adaptability and innovation

In addition to providing benefits to health programmes and systems functioning and impact, learning can also support other valuable capacities. One of these is the ability of systems to prepare for and respond to crises and upheavals or changes of many kinds through capacity for adaptability and innovation.

Building on the overview of how different components of the learning health systems framework can enable us to analyse and understand different examples of learning and how they support health systems in the previous section — including the video in section 3.2 — in this section, we will look at examples of anticipating and responding to change. We will look at an example of how health systems can adapt through learning and how learning can facilitate innovation and the changes and benefits that health systems can reap from these.   

Learning through adaptation

Adaptation can include making changes in societal expectations, population characteristics and disease patterns, to external shifts including political and economic upheavals, natural disasters, and global ecological trends. Learning to correct mistakes and adapt to contextual changes. Health systems that are ready to recognize and correct mistakes are in a better position to adapt and tailor actions to meet these changes.

Example of adaptation in practice: Barbados

Barbados utilized an adaptive approach to learn from its management of dengue fever. The previous outbreak-detection strategy had relied on monitoring caseloads and anticipating seasonal surges. The Ministry of Health and Welfare (MFW) led a process of development of a climate-informed early warning systems, which provided quantitative predictive models of outbreak risk and favorable conditions for disease transmission.

A project team was set up comprised of MFW workers, the Caribbean Institute for Meteorology and Hydrology, and interdisciplinary researchers with climate risk, social science, and epidemiology and modeling skills. The aim of this team was to develop the in-house capacity to processing a decade of disease case data as well as run ongoing forecasts going forward.

This team engaged in rounds of learning to understand issues across sectors and among stakeholders starting in 2017. Working together, they co-developed an emergency warning system. While resource constraints have slowed the scale up from the pilot and the direct learning has so involved few leaders, the receptiveness of the team to new information marks an important though subtle advance in how they approach other challenges, too. For example, the experience of working with modelers from this EWS collaboration prompted the early outreach to a local institution to conduct modeling for the country’s ongoing COVID-19 response. Further, the MHW has sustained policy support for research-informed decision-making and collaborations among stakeholders.

The Learning Health Systems report on pages 32-33 includes additional examples of learning through adaptation, including in Thailand.

Learning through innovation

In addition to being able to adapt to changing circumstances, driving that change through innovation is also often necessary. Successful innovation usually requires that reasonable experimentation and risk-taking are accommodated or actively encouraged. They also often have the ability to assess and codify innovations for future use and scale up. Resilience to overcome challenges and learn from failures or mistakes is also key.

Example of innovation in practice: Ghana

Ghana’s Ridge Regional Hospital and the Greater Accra regional Health Directorate were confronted with a shortage of skilled anesthesia staff. In 2008, this long-standing issue became an acute crisis. The effects on quality and timeliness of care delivery of emergency obstetric care were substantial, and this impeded the work to reduce maternal and neonatal mortality.

A rapid appraisal was conducted to understand the situation and devise potential solutions considering the context and what was relevant, feasible and legitimate. They tapped into tacit knowledge and experiential knowledge and observations of senior managers, clinicians and nurses. In addition, the health management information system provided routine data for analysis.

The core finding was the impact on surgery due to lack of skills anesthesia staff. The source of evidence concluded that more schools were needed to produce adequate nurse anesthesiologists in the short and medium term. Further, the Ridge hospital was encouraged to make a bold move and set up a training school themselves.

While rolling out these plans, several challenges were encountered, including opposition by key stakeholders. However, the experiment led to important learning that mapping and understanding key stakeholders during a planning and innovation process was critical. Listening to and responding to concerns was essential in keeping everyone onboard as supporters. Now, this school is an established and respected institution that produces an ongoing supply of nurse anesthesiologists (300 in its first decade of operation).

© WHO / Blink Media – Nana Kofi Acquah Nurses working in the reception area of Accra’s Ridge Hospital during the beginning of Ghana’s national COVID-19 vaccination campaign.

In the Learning Health Systems report, you can read more about the examples presented here and also explore additional examples on pages 32-36.