LAUSR

I health outcomes and making the delivery system more effective rely on meaningful collaboration of patients, providers, and teams. Health care is improving, but more change is needed. Since the 1990s, organizational learning has been promoted as a change management process, and these principles have made their way into health care. Learning health care systems (LHSs) are organizations where “science, informatics, incentives, and culture are aligned for continuous improvement and innovation.” In 2013, the Institute of Medicine proposed that health care organizations transform into learning systems characterized by effective integration of science and informatics, patientclinician partnerships, incentives, and culture. Many institutions, including Johns Hopkins Medicine, have created leadership and structural systems to promote learning, accountability, and change. Primary care providers (PCPs) have a unique role within an LHS. In addition to first contact, prevention, coordination, and stewardship, PCPs provide the majority of care to patients with chronic, complex illnesses. Through partnerships with providers, researchers, and educators, PCPs can improve care and enhance performance of the entire LHS. Primary care providers perceive that lack of time is the biggest barrier to safe, high-quality practice. Working with top-of-license support teams is a suggested solution to the provider time crunch. For example, our clinical support teams are responsible for completing more than 15 standard intake processes; we delegate other processes based presenting complaints of patients. However, clinical support staff may lack competency in basic clinical skills and knowledge, making it difficult, if not unsafe, to delegate more care. Johns Hopkins Community Physicians employs more than 1300 individuals, including 240 clinicians who provide primary care to more than 250 000 patients. We have central management functions coordinating quality, safety, operations, information technology, and research and education, and consider