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Enhancing Learning, Innovation, Adaptation, and Sustainability in Health Care Organizations: The ELIAS Performance Management Framework

Persaud, D. David PhD

doi: 10.1097/HCM.0000000000000014

The development of sustainable health care organizations that provide high-quality accessible care is a topic of intense interest. This article provides a practical performance management framework that can be utilized to develop sustainable health care organizations. It is a cyclical 5-step process that is premised on accountability, performance management, and learning practices that are the foundation for a continuous process of measurement, disconfirmation, contextualization, implementation, and routinization This results in the enhancement of learning, innovation, adaptation, and sustainability (ELIAS). Important considerations such as recognizing that health care organizations are complex adaptive systems and the presence of a dynamic learning culture are necessary contextual factors that maximize the effectiveness of the proposed framework. Importantly, the ELIAS framework utilizes data that are already being collected by health care organizations for accountability, improvement, evaluation, and strategic purposes. Therefore, the benefit of the framework, when used as outlined, would be to enhance the chances of health care organizations achieving the goals of ongoing adaptation and sustainability, by design, rather than by chance.

Author Affiliation: School of Health Administration, Dalhousie University, Halifax, Canada.

The author has no conflict of interest.

Correspondence: D. David Persaud, PhD, School of Health Administration, Dalhousie University, 5161 George St, Ste 700, PO Box 15000, Halifax, Nova Scotia, B3H 4R2, Canada (

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