Over the last 10 years, the pediatric healthcare community has worked together to create network-based collaborative learning health systems affecting multiple conditions,1 hundreds of healthcare institutions, and thousands of healthcare professionals, patients, and families—directly impacting millions of children.
These networks have cut serious safety events in pediatric hospitals by half2 and mortality from hypoplastic left heart syndrome by 40%3 and have improved remission rates of children with Crohn disease and ulcerative colitis by 33%.4 In addition, scheduled (early elective) deliveries before 39-week gestation that lack a documented medical indication have been reduced by 40%.5
Networks are a needed innovation because health care is an increasingly complex and ever-evolving industry. Networks enable facilitated, focused collaboration and serve as a way to improve outcomes, experience, and value of care. They have also spawned innovations and increased the efficiency of research. There is a growing demand to create more networks across many pediatric and adult conditions.
We know that networks are widespread across many other industries. Wikipedia is perhaps the best example of a successful collaborative network that engages a large community to produce useful information. We also see it effectively used in the hospitality/travel industry. In science, collaboration among researchers accelerated the sequencing of the human genome.
Based on our experience in health care, successful networks share these attributes:
- Involvement of patients and their families: Clinicians and researchers cannot do it alone. They need to do it in partnership with others—especially patients and families.
- A clear purpose of changing outcomes across the network driven by participants who want to contribute to something big.
- An understanding that the network is primarily a social construct, that is, it is a community where relationships matter. This requires management of ongoing issues of self-governance, decision-making, standardization, and communication. It’s hard work, and if you cannot build and manage the social piece, you will fail.
- Open sharing of data and best practices: Success is built on the belief that by transparently sharing successes and failures and learning from one another, the network can achieve its goals more effectively and quickly than working alone. This is particularly important in pediatric health care where there are 7,000 rare diseases that could potentially benefit from a networked approach.
- Agreement to compete on execution, not ideas: On pediatric hospital safety, we have agreed not to compete because networks succeed when everyone has the same access to good ideas.
- Senior leadership support to provide the sponsorship, communications platform, and influence necessary for the difficult work ahead.
- Management agreement to catalyze these efforts with initial and ongoing funding while helping to garner additional resources over time.
- Commitment to and investment in building a culture using strategies from other high-reliability, high-performing organizations to help create a winning culture.
- A strong, effective technical infrastructure to gather, enter, and report data.
- A range of scientific methods, including improvement and reliability science and clinical and quality research used, to measure progress.
All of us who have been entrusted with the great responsibility and privilege of caring for children, helping to heal children, and giving hope to children and their families are excited by the difference we can make by working together. Although networks are a relatively new concept made possible in large part by the efficiency and speed of digital communication, they work because they tap into the fundamental human drive to be a part of something bigger than yourself, to be generous, and to help others.
The author has no financial interest to declare in relation to the content of this article.
1. Lannon C, Peterson L. Pediatric collaborative networks for quality improvement and research. Acad Pediatrics 2013;13:S69–S74.
3. Anderson JB, Beekman RH 3rd, Kugler JD, et al. Improvement in interstage survival in a national pediatric cardiology learning network. Circ Cardiovasc Qual Outcomes 2015;8:428–436.
4. Crandall WV, Margolis PA, Kappelman MD, et al. Improved outcomes in a quality improvement collaborative for pediatric inflammatory bowel disease. Pediatrics 2012;129:e1030–e1041.