This toolkit is designed to support staff and clinicians at Women’s College Hospital to be active members of our Learning Health System.
The toolkit may also provide a useful guide to others, outside of the hospital, who are developing or working within their own Learning Health System.
While some material in the toolkit may not be relevant to hospital patients, Experience Advisors, and other individuals with lived/living experience, everyone is still encouraged to review the toolkit as specific sections may still be useful. In particular, check out the Learning Community section to learn more about how to get involved.
Click here to learn more about becoming a Women’s College Hospital Experience Advisor.
This toolkit is designed to support staff and clinicians at Women’s College Hospital to be active members of our Learning Health System.
The toolkit may also provide a useful guide to others, outside of the hospital, who are developing or working within their own Learning Health System.
While some material in the toolkit may not be relevant to hospital patients, Experience Advisors, and other individuals with lived/living experience, everyone is still encouraged to review the toolkit as specific sections may still be useful. In particular, check out the Learning Community section to learn more about how to get involved.
Click here to learn more about becoming a Women’s College Hospital Experience Advisor.
A Learning Health System involves the use of feedback and data to make improvements to patient care in real-time. In other words, we learn from experience or “practice” in the hospital, convert that practice into “data” that we can look at more deeply to gain “knowledge,” which we use to improve practice. A Learning Health System is an ongoing journey and there is a lot of overlap between steps. We hope the resources presented in this toolkit can help guide your learning journey.
Have you articulated your question of interest or problem you are trying to learn more about?
YES
Great! If you have already consulted with your Learning Community, you may want to start with the Practice to Data section which helps you identify what data is available at the hospital, or the type of new data you may want to collect.
NO
That’s ok! If you do not have a specific question, but do have a topic of interest, you may want to consult your Learning Community to develop an area to focus on. Reviewing the Practice to Data section will also provide some guidance on external information about best practice guidelines and priority areas for WCH.
Do you know what data you need to use to answer your question?
YES
If you already know what data is available, the Data to Knowledge section will guide you through what approvals you may need to access existing data or collect new data through surveys, interviews, and/or focus groups.
NO
If you do not know what data is needed to answer your question, consulting your Learning Community, and reviewing the Practice to Data section may provide some guidance on where to learn more about available data.
Do you already have data, results, and are looking to learn about how to change practice?
YES
If you already know what data is available, the Data to Knowledge section will guide you through what approvals you may need to access existing data or collect new data through surveys, interviews, and/or focus groups.
NO
If you do not know what data is needed to answer your question, consulting your Learning Community, and reviewing the Practice to Data section may provide some guidance on where to learn more about available data.
How does my topic/question align with the priorities of Women’s College Hospital?
More generally, the Learning Health System at WCH underpins all three strategic directions of the Healthcare Revolutionized 2030 WCH Strategy. In order to create a system…
that enables improvement to occur routinely
is designed to support everyone in a nimble and streamlined fashion, and
in which trusted knowledge generated from analysis of data is rapidly available to support strategies and decisions
We have designed this LHS toolkit as part of this infrastructure that will help to power the WCH strategy.
Note: We have organized this Toolkit into a suggested sequence of categories. However, we understand that there may be some overlap between where a category belongs (e.g., in Practice to Data and/or Data to Knowledge). This Toolkit is meant to serve as a guide, following common practices. For example, in general, before obtaining institutional approvals, one would need to know what type(s) of data to collect. For this reason, we have placed “COLLECTING New Data” under Practice to Data before STARTING a New Project under Data to Knowledge.
Acknowledgements
In the compilation of this toolkit, we would like to express our sincere gratitude to the following individuals:
Principal Authors: Celia Laur PhD, Soumia Meiyappan MSc, PMP
Learning Health System Collaboratory Working Group
Catharine Butler
Victoria Ennis
Chandra Farrer
Elaine Goulbourne
Theresa Kay
Natasha Kithulegoda
Zeenat Ladak
Elizabeth (Libby) Masters
Jennifer Shuldiner
Vanessa Wright
Experts consulted (non-Working Group Members):
Chris Battiston
Monica Bustos
Brenda Chin
Nicole Do
Julia DeMaria
Vicky Forster
Anne Forsyth
Stephanie Hatzifilalithis
Daniel Jin
Yonda Lai
Sangeetha Navaratnam
Joyce Nyhof-Young
Neha Patel
Marie Pinard
Evelina Rutkowski
Marie Steele
Safiya Tohob
Special thanks to Anita Duraikannan from Strategic Communications for building this toolkit onto our public-facing and internal websites.
The Section at a Glance:
Engaging People in the Organization
Engaging People with Lived Experience
Commitment to Equity
Indigenous Health
Learning Community
A Learning Community is a group of interest holders, including people/partners with lived/living experience (current and former patients, families, care providers, community etc.) clinicians, managers, administrators, researchers, technical staff, and others, who come together to achieve collective improvement. The Learning Community is the core of a Learning Health System.
At WCH we have a collective Learning Community that is developing WCH as a Learning Health System overall. You may also have your own learning community focused on the improvement you are trying to make.
ENGAGING People in the Organization
Early in your journey, you’ll want to identify the people that are most relevant to your work. Ideally, this will include a mix of people from across the hospital (and outside the hospital if relevant) including staff, clinicians, researchers, and individuals with lived experience (see below).
Having multiple perspectives can help ensure you are asking the right questions, collecting the right information, and interpreting your results in a way that is beneficial and understandable to those impacted by the results.
WCH Nurse Sue MacRae and her team from the Trauma Therapy Program in the Department of Psychiatry brought together Quality Improvement, IT, clinicians, etc., to form an interdisciplinary team to collaborate on local operational changes. The framework they follow is an excellent example of how different teams can work together to improve care for our patients.
Details of the team’s experience were written up for the WCH Day of Excellence, an annual internal conference that showcases the best of learning and discovery taking place at WCH.
The poster is entitled: “Leading Local Operational Change in the Trauma Therapy Program at Women’s College Hospital using the Collaborative Approach to Managing Innovation (CAMI) Model.”
Clinicians and Staff:
There is a lot to learn from individuals throughout the hospital. Learning from clinicians, staff etc. can be through brief conversations, asking questions during existing meetings, or through more formal surveys, focus groups, or interviews. See the Practice to Data section to learn more about collecting this data more formally. The Designing for Change section within Knowledge to Practice will also be useful for this process.
Researchers:
WCH is connected to an extensive network of researchers. Even if someone with the expertise you need is not based at the hospital, researchers may be able to connect you with the relevant people. Review the Academics section of the website and Data to Knowledge section to learn more about what research is happening across the hospital and the Scientists involved.
Trainees:
Would your project make a unique learning opportunity for a trainee? Check out the Learning Institute page to learn more about opportunities for identifying and supporting trainees. If you are interested in training and education, your work might be an excellent fit for a summer student through the Education Scholarship Accelerator Program (ESAP). Contact Joyce Nyhof-Young to learn more: Joyce.NyhofYoung@wchospital.ca
Community:
Are you interested in engaging with the communities connected to Women’s College Hospital? Connect with the Community Based Research group to learn more about working with the community. Contact Stephanie Hatzifilalithis to learn more: stephanie.hatzifilalithis@wchospital.ca
ENGAGING People with Lived Experience
Engaging people with lived experience (current and former patients, families, care providers, community etc.; PWLE) in a Learning Health System is essential for ensuring that the questions we ask and the way we provide answers are relevant, meaningful, and grounded in real-world needs.
By challenging assumptions and highlighting overlooked issues, PWLE contribute to better care that aligns with the needs of our patients. Engaging PWLE also builds trust and transparency, particularly among groups historically underrepresented in health research. Ultimately, this approach supports more equitable and impactful improvements in care and health outcomes for our patients.
Anyone at WCH who would like assistance and advice on including PWLE in their research, quality improvement, and program evaluation projects can contact our patient and community engagement lead, Vicky Forster at victoria.forster@wchospital.ca. Vicky can provide assistance with integrating PWLE as advisors into every stage of a project from grant proposal to knowledge translation. Vicky can also advise on the recruitment of people with lived experience for projects and navigating processes such as onboarding and compensation.
Click here and go to the Resources tab to learn more about engaging individuals with lived experience within research and quality improvement projects
Research and quality improvement projects often require PWLE with specific experiences and/or from particular demographics to ensure that their expertise and input is most relevant to the project. Sometimes, these people can be recruited from programs at WCH (see below) but often, researchers will find PWLE to engage with from a variety of different sources, including: community, or advocacy groups, organizations or charities, or their own clinics or programs. Open calls via recruitment posters both in the hospital and on social media may also be used, if it makes sense for your work. The best way to recruit PWLE depends on the type and nature of the project, and the needs of the engagement.
Vicky Forster is available to advise on recruitment strategies for individual projects at WCH. victoria.forster@wchospital.ca.
At WCH, one way to engage people with lived experience is through the Experience Advisor Program—a community of patients, care partners, family members, and community members who share their stories, perspectives, and expertise to improve patient care. Experience Advisors work in partnership with hospital leaders, healthcare providers, and staff, offering valuable insights that inform the design and delivery of care, programs, and services across the hospital. Experience Advisor engagement is integral to ensuring that healthcare services are high-quality and responsive to the needs of the diverse patients and communities WCH serves.
For more information about the Experience Advisor program and how to engage with them, visit our Experience Advisor webpage.
The following Experience Advisor Toolkit provides some helpful information about the program and the different ways to engage with Experience Advisors.
The following Planning Form should be submitted by WCH staff and/or clinicians to request Experience Advisor involvement in a project/initiative.
Equity Mobilizing Partnerships in Community (EMPaCT) is a novel and scalable patient partnership model co-designed to centre the voices of diverse community members and build capacity for equity-promoting patient-oriented decision-making in healthcare.
EMPaCT was co-designed by diverse members of community as a space where:
People with diverse lived/living experiences can engage with health and social system decision-makers in a safe way
The collective lived/living experiences of people are mobilized into knowledge through community-based Health Equity Analysis
Recommendations are provided to decision-makers on how to make their projects more inclusive and equity-promoting
New research questions and policy directives are initiated that are person-centred and community-driven
ty engagement. WCH Academics is developing a roadmap to advance cultural inclusion and research ethics with Indigenous and Black communities with a goal to strengthen health equity through ethical research practices.
Equity should be considered in every step of a Learning Health System, from the initial questions being asked, the way data are collected, the voices at the table, and the way data are applied throughout the hospital.
The Allyship Toolkit provides a comprehensive understanding of allyship within healthcare from its foundational concepts to practical applications with patients and colleagues and extends to the inclusion of allyship principles in health research practices.
The Centre for Wise Practices Website serves as a comprehensive platform dedicated to Indigenous health at WCH. The Centre aims to address the unique healthcare needs of Indigenous communities by providing a wealth of resources, information, and support. With a focus on fostering culturally sensitive and inclusive healthcare practices, we aim to promote health equity, and share initiatives and programs aimed at improving the well-being of Indigenous individuals.
Through a combination of educational content, community engagement, and healthcare advocacy, the site seeks to contribute to the advancement of Indigenous health outcomes and bridge gaps in healthcare access and understanding.
In a Learning Health System, data, such as information from electronic medical records, and patient or staff surveys etc., provide an opportunity to learn from every patient who is treated. By collecting and understanding that data with your Learning Community, you can see what is happening in the hospital (your “system”), including showcasing success, and identifying opportunities for improvement.
When learning from data from your system, it is also important to know what others have done on the topic so you can have a deeper understanding of best practice recommendations, questions to be asked, and what else you need to consider.
Patient data can be generated within your healthcare organizations or elsewhere, and can be viewed alongside data about staff, facilities, finance, the environment, etc., so you see a more complete picture of what is happening in your system. When reviewing existing data (i.e. administrative data from an Electronic Medical Record) or collecting new data, it is important to consider:
How was/is the data captured? (Electronic medical records, surveys etc.)
Where is the data from? (Collected for administrative purposes, for a system-wide experience survey etc.)
How can existing data be accessed? (Approval processes etc.)
Who can access the data? (Consent to use data etc.)
How is/will the data be stored? (electronic or hardcopy)
How is/will data be kept secure?
REVIEWING the Evidence
Best Practice Spotlight Organizations (BPSOs) are health care and academic organizations selected by the Registered Nurses’ Association of Ontario (RNAO) through a request for proposals process to implement and evaluate the RNAO’s best practice guidelines. Women’s College Hospital is a Best Practice Spotlight Organization and has implemented Best Practice Guidelines specific to this hospital. Click here to learn more: https://www.womenscollegehospital.ca/accountability-and-quality/bpso/
Best Practice Guidelines are a great place to start to find out if there are already recommendations about your topic of interest. Developed by the RNAO there are more than 50 Best Practice Guidelines covering nine categories:
Reviewing the evidence about what is already known about your topic could begin with a brief search of relevant websites and papers to identify similar work, through to a full systematic review of the literature.
Still have questions about your literature review? WCH has a librarian who can help! Contact Neha Patel: neha1.patel@wchospital.ca
ACCESSING Existing Data
WCH already collects a lot of information about our patients and staff. Finding out what data is already collected is important to support improvements as part of a Learning Health System.
Patient data are generally collected in one of two electronic patient record (EPR) systems we have at the hospital: Epic for hospital data and TELUS PS Suite for family practice data. We also have staff experience surveys that help identify strengths and opportunities for improvement across the hospital.
To request access to data or if you have a question about what data are available, please contact the Decision Support team by completing this form: Decision Support Data Request Intake Form.
NOTE: Before you have access to any data, you may need to receive the appropriate approvals so we can make sure we are protecting the privacy of our patients and staff. See the Data to Knowledge section to help decide if you need approval, and if so, what type.
As WCH has a Research and Innovation Institute, some data may already be available through previous research projects. Contact the relevant Scientists to learn more about their previous or ongoing work, if results are already available, and if there are opportunities to ask new questions of previously collected data (this may not always be possible).
If the data you need to answer your question is not already collected by the hospital, you may need to collect your own data. Remember to review the Data to Knowledge section before starting to collect data to make sure you have the correct approval.
Using a survey to ask questions offers several key benefits:
Efficient Data Collection: Surveys allow you to gather information from a large group of people in a short amount of time, making them practical for research or feedback.
Consistency: Everyone answers the same set of questions, making it easier to compare and analyze the results.
Variety of Questions: Surveys can include different types of questions, such as multiple-choice for clear answers or open-ended questions for more detailed opinions.
Flexible Delivery: Surveys can be conducted in different ways including online, on paper, or by phone, so they can reach a wide range of people.
At WCH, surveys that include personal information are administered through a program called REDCap, which is a secure web platform for building and managing online databases and surveys. REDCap’s streamlined process for rapidly creating and designing projects offers a vast array of tools that can be tailored to virtually any data collection strategy.
WCH REDCap Support Services regularly hosts twice-weekly REDCap drop-in sessions to support our researchers in addition to the documented training materials. Drop-in sessions are intended to provide an informal opportunity for research teams that may require more complex solutions specific to their projects. Pre-registration is not required.
Please note that WCH REDCap training sessions and support services are provided for the benefit of WCH staff and researchers only.
Interviews and focus groups are a great way to collect detailed information about people’s experiences, opinions, and motivations, which cannot always be captured with surveys or numbers alone. These methods help us understand not just what people think, but also why they think that way, giving us deeper insights into their feelings and perspectives.
Interviews are most useful when you want in-depth personal information from individuals, especially about sensitive or complex topics where privacy matters. Interviews also allow for more follow-up questions and exploration of each person’s unique viewpoint in detail.
Focus groupsare helpful when you want to gather a range of opinions and see how people discuss and react to each other’s ideas in a group setting. They are useful for exploring shared experiences, testing new ideas, or understanding how social dynamics influence opinions. Focus groups are also useful when you want to see group interactions or when you need quick feedback from several people at once.
NOTE: You will likely need WCH approval before collecting survey or interview/focus group data! See Data to Knowledge for details.
Sex and Gender Considerations
WCH is a leader in the promotion of Sex- and gender-based analysis plus (SGBA+) across all health research.
SGBA+ is embedded into our DNA at WCH and aligns with our wider organizational mandate – the pursuit of equity for all. Inclusive health research that incorporates diversity by taking factors beyond sex and gender into account has the capacity to benefit everyone.
Need support integrating sex and gender+ into your work? The Sex and Gender+ Research Support Service is a unique research knowledge translation and capacity-building initiative within WCH with the aim of advancing and supporting the integration of an intersectional sex and gender lens (SGBA+) in health research in Ontario and beyond.
Depending on your project, you may also be eligible for external funding:
The Grants Office sends a bi-weekly newsletter with a list of relevant funding opportunities for WCH staff and researchers. Contact Nicole Do (Nicole.do@wchospital.ca) to be added to the email list.
Don’t forget that when applying for external funding, you will need to submit an internal application package ten business days before the agency deadline to make sure you can receive additional feedback and obtain required signatures. See the Grants Office page for details.
Please feel free to contact the Grants Office if you require any support determining your eligibility to apply, understanding agency and application requirements, and developing your funding applications.
Depending on your idea, you may also be able to connect with the Women’s College Hospital Foundation. See the Foundation’s website for details and contact foundation@wchospital.ca if you have further questions.
This Section at a Glance:
Starting a New Poroject
Deciding between Quality Improvement or Research
Deciding between Quality Improvement and Quality Assurance
