Congratulations! You made it through your first LHS cycle.
You’ll now see how the right real-time data, infrastructure, digital solution, adequate planning, cross-disciplinary teamwork and institutional support, can transform care, and how you can be part of shaping a smarter, more adaptive healthcare system.
Now it’s time to go back and start again with a new problem. You can explore the cycle after closing this window.
3. Assemble the data
How do we clean, harmonise, and link data so they can be analysed together?
Is the assembled dataset reliable enough to support learning and decision-making?
Before data from multiple sources can be combined, it must be cleaned and standardised. Key fields such as patient identifiers, dates, medications, and codes, need to be aligned so datasets can be accurately linked. This harmonisation reduces errors and ensures a reliable, system-wide view of the problem.
1. Define the problem & collect relevant data
What exactly is happening, to whom, where, and under what conditions?
Have we framed the problem clearly enough to be measured and acted on?
What is the most appropriate first step when collecting data?
Option 4
Option 2
Option 1
Option 3
Correct!
Not the best choice.
Let's explore other options.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Try again.
Compare your hospital to national averages
Interview patients to understand why they can’t manage their diabetes at home
Interview ED clinicians to understand their observations
Pull de-identified ED presentation data for all diabetes related visits over the past 12 months
This option collects objective, foundation-level data before gathering perspectives
Title
Title
Title
Title
Write a brief description here
Write a brief description here
Write a brief description here
Write a brief description here
5. Interpret results
What do these findings mean in real-world clinical and operational context?
Do we understand the likely drivers of the problem well enough to intervene?
The team discovers that many presenting patients had rising HbA1c, complex polypharmacy, missed follow-up, and issues with monitoring their disease. What is the best interpretation of possible insights?
Option 4
Option 3
Option 1
Option 2
Correct!
Don't jump to conclusions!
Nope!
Not the best interpretation.
Clinicians should provide more adequate education on diabetes management
Lack of appropriate technology for self-management is the problem
The pattern suggests interacting system barriers affecting diabetes self-management.
ED patients lack discipline with self-management
Recognises complex adaptive system dynamics at play
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Title
Title
Title
Title
Write a brief description here
Write a brief description here
Write a brief description here
Write a brief description here
2. Identify data sources
What data already exist that can help us understand this problem across the care continuum?
Which data sources are necessary versus nice-to-have?
No single dataset shows the full picture of care for people with diabetes presenting to the ED. A system-wide view comes from combining data across the patient journey, such as ED records, outpatient notes, and GP follow-up data. Together, these sources support systems thinking and meaningful analysis.
9. Measure the impact (evaluate)
What outcomes will tell us whether the change is helping, harming, or neutral?
Are the measures sensitive and timely enough to guide adaptation?
Early implementation highlights both enablers and barriers to adoption. Executive support and alignment with key workflows drive uptake, while clinician time constraints and delayed EMR integration slow progress. Identifying these factors helps teams refine implementation strategies and target support where it matters most.
4. Analyse data
What patterns, variation, or associations are present in the data?
Are the observed patterns meaningful, consistent, and actionable?
Once datasets are merged, the team runs preliminary analyses. Which question best reflects appropriate early analysis?
Question 4
Question 3
Question 1
Question 2
Correct!
Not the best choice.
Let's explore other options.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Try again.
Do all the patients share similarities in socioeconomic status?
Which patients are in ED due to non-adherence?
Can we find out which clinics the most ED visits came from?
Are there patterns in and around preceding ED visits?
This investigates patterns and relationships, not premature solutions. Eg. HbA1c levels, follow-up attendance, or medication changes.
Title
Title
Title
Title
Write a brief description here
Write a brief description here
Write a brief description here
Write a brief description here
12. Continuously learn and adapt
Six months after full implementation, ED presentations drop further, but a new issue emerges: rising phone triage calls. What should you do?
Option 1
Option 4
Option 2
Option 3
Correct!
Not the best choice.
Let's explore other options.
Try again.
Ignore it, ED visits went down, this is out of scope
Trial a new intervention
Add more staff to triage
Re-enter the LHS cycle
Gather data, generate insights, apply the insights to practice and refine the system. An LHS never stops learning, adaptation is continuous.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Title
Title
Title
Title
Write a brief description here
Write a brief description here
Write a brief description here
Write a brief description here
8. Prototype in a safe environment
How can we test this solution without risking patient safety or disrupting care?
Is the prototype ready for limited real-world exposure?
Before implementing a new workflow, it should be tested safely using low-risk prototyping. Simulation and role-play with realistic cases, supported by sandbox versions of digital tools, help identify workflow, usability, and safety issues early, allowing refinement before real patients and clinicians are affected.
0. Identify a problem of interest
What recurring issue is causing harm, inefficiency, or inequity in the system?
Is this problem important enough and common enough to warrant system-level learning?
You assemble a learning community with relevant stakeholders. The team wants to define the problem to be investigated. Find the problem statement best reflects an LHS mindset:
Correct!
Option 4
Option 3
Option 1
Option 2
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
This prematurely blames primary care, assuming a cause before any data is collected and analysed.
This places responsibility solely on patients and ignores broader system factors such as access to care, medication complexity, digital integration, or socio-economic barriers.
This focuses on the hospital’s internal capacity rather than asking why the ED is experiencing increased volume in the first place.
Primary care services are failing to prevent diabetes complications before they escalate to ED visits.
There has been a rise in ED presentations among patients with diabetes, and we need to understand system-level factors contributing to this trend.
Patients with diabetes are not managing their condition well, leading to unnecessary ED presentation.
The hospital needs better resources to handle the increasing number of diabetes-related ED visits.
This focuses on a system pattern exploration, not blame or assumptions.
Title
Title
Title
Title
Write a brief description here
Write a brief description here
Write a brief description here
Write a brief description here
11. Scale and embed change
How do we scale and sustain this change across the system?
What needs to be standardised, supported, or governed to make this routine practice?
You’re now ready to scale the solution after getting through governance and executive buy-in. What’s the best strategy to ensure it becomes embedded?
Option 2
Option 1
Option 4
Option 3
Correct!
Not the best choice.
Let's explore other options.
Try again.
Email everyone the new protocol and timelines for implementation
Implement the intervention and immediately move on to the next project to save time
Leave it to each clinician to decide whether to use it and how
Provide training, update workflows, assign champions, and monitor early adoption
Embedding change requires structured rollout and support.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Title
Title
Title
Title
Write a brief description here
Write a brief description here
Write a brief description here
Write a brief description here
10. Implement the intervention
Can this intervention be integrated into routine practice in a way that's sustainable?
Do we embed this as a standard organisational capability, or allow it to remain a one-off project outcome?
During early implementation, the project team notices that uptake varies across teams. They conduct interviews and find the following:
- Some clinicians feel they don’t have time to learn the new workflow.
- Several diabetes nurse educators say the pathway is easy to use and aligns with their current practice.
- The IT team reports delays integrating data into the EMR.
- Executive express strong support and have encouraged staff to trial the pathway.
It was found that strong leadership support and good workflow alignment were enablers of implementation, while time constraints and IT integration issues were barriers.
7. Map and refine workflows
How would these solutions change day-to-day work for different system players?
Can the workflow changes realistically be integrated into existing practice?
The team is mapping the current workflow for diabetes follow-up, in order to see where their solution fits. What’s the most useful step?
Option 4
Option 2
Option 1
Option 3
Correct!
Not the best choice.
Let's explore other options.
Try again.
The workflow is obvious, so move straight to designing the intervention
To save time and resource, ask one clinician to describe their workflow
Map the workflow from each stakeholders perspective
Focus only on the ED process as this is where an intervention is required
Systems problems require multi-perspective workflow mapping. E.g. patients, ED staff, community care teams, pharmacy and EMR
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Title
Title
Title
Title
Write a brief description here
Write a brief description here
Write a brief description here
Write a brief description here
6. Brainstorm solutions
What changes could plausibly address the identified drivers?
Which solutions are feasible, acceptable, and aligned with system constraints?
During solution generation, which approach best aligns with team science and LHS principles?
Option 2
Option 4
Option 3
Option 1
Correct!
Let's explore other options.
Not the best choice.
Try again.
Choose the most cost-effective option
Bring together key stakeholders to co-design a solution
Let the IT department decide on a digital tool as this is their remit
Hold a workshop with clinical staff, to generate solutions
It is essential to consider the voices, expertise, lived experience and perspectives of all end users. Eg. clinicians, data analysts, IT, EMR, administration staff, and consumers to co-design ideas that will work for everyone.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Title
Title
Title
Title
Write a brief description here
Write a brief description here
Write a brief description here
Write a brief description here
LHS scenario V2
CDTH
Created on December 17, 2025
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Transcript
Congratulations! You made it through your first LHS cycle.
You’ll now see how the right real-time data, infrastructure, digital solution, adequate planning, cross-disciplinary teamwork and institutional support, can transform care, and how you can be part of shaping a smarter, more adaptive healthcare system. Now it’s time to go back and start again with a new problem. You can explore the cycle after closing this window.
3. Assemble the data
How do we clean, harmonise, and link data so they can be analysed together?
Is the assembled dataset reliable enough to support learning and decision-making?
Before data from multiple sources can be combined, it must be cleaned and standardised. Key fields such as patient identifiers, dates, medications, and codes, need to be aligned so datasets can be accurately linked. This harmonisation reduces errors and ensures a reliable, system-wide view of the problem.
1. Define the problem & collect relevant data
What exactly is happening, to whom, where, and under what conditions?
Have we framed the problem clearly enough to be measured and acted on?
What is the most appropriate first step when collecting data?
Option 4
Option 2
Option 1
Option 3
Correct!
Not the best choice.
Let's explore other options.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Try again.
Compare your hospital to national averages
Interview patients to understand why they can’t manage their diabetes at home
Interview ED clinicians to understand their observations
Pull de-identified ED presentation data for all diabetes related visits over the past 12 months
This option collects objective, foundation-level data before gathering perspectives
Title
Title
Title
Title
Write a brief description here
Write a brief description here
Write a brief description here
Write a brief description here
5. Interpret results
What do these findings mean in real-world clinical and operational context?
Do we understand the likely drivers of the problem well enough to intervene?
The team discovers that many presenting patients had rising HbA1c, complex polypharmacy, missed follow-up, and issues with monitoring their disease. What is the best interpretation of possible insights?
Option 4
Option 3
Option 1
Option 2
Correct!
Don't jump to conclusions!
Nope!
Not the best interpretation.
Clinicians should provide more adequate education on diabetes management
Lack of appropriate technology for self-management is the problem
The pattern suggests interacting system barriers affecting diabetes self-management.
ED patients lack discipline with self-management
Recognises complex adaptive system dynamics at play
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Title
Title
Title
Title
Write a brief description here
Write a brief description here
Write a brief description here
Write a brief description here
2. Identify data sources
What data already exist that can help us understand this problem across the care continuum?
Which data sources are necessary versus nice-to-have?
No single dataset shows the full picture of care for people with diabetes presenting to the ED. A system-wide view comes from combining data across the patient journey, such as ED records, outpatient notes, and GP follow-up data. Together, these sources support systems thinking and meaningful analysis.
9. Measure the impact (evaluate)
What outcomes will tell us whether the change is helping, harming, or neutral?
Are the measures sensitive and timely enough to guide adaptation?
Early implementation highlights both enablers and barriers to adoption. Executive support and alignment with key workflows drive uptake, while clinician time constraints and delayed EMR integration slow progress. Identifying these factors helps teams refine implementation strategies and target support where it matters most.
4. Analyse data
What patterns, variation, or associations are present in the data?
Are the observed patterns meaningful, consistent, and actionable?
Once datasets are merged, the team runs preliminary analyses. Which question best reflects appropriate early analysis?
Question 4
Question 3
Question 1
Question 2
Correct!
Not the best choice.
Let's explore other options.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Try again.
Do all the patients share similarities in socioeconomic status?
Which patients are in ED due to non-adherence?
Can we find out which clinics the most ED visits came from?
Are there patterns in and around preceding ED visits?
This investigates patterns and relationships, not premature solutions. Eg. HbA1c levels, follow-up attendance, or medication changes.
Title
Title
Title
Title
Write a brief description here
Write a brief description here
Write a brief description here
Write a brief description here
12. Continuously learn and adapt
Six months after full implementation, ED presentations drop further, but a new issue emerges: rising phone triage calls. What should you do?
Option 1
Option 4
Option 2
Option 3
Correct!
Not the best choice.
Let's explore other options.
Try again.
Ignore it, ED visits went down, this is out of scope
Trial a new intervention
Add more staff to triage
Re-enter the LHS cycle
Gather data, generate insights, apply the insights to practice and refine the system. An LHS never stops learning, adaptation is continuous.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Title
Title
Title
Title
Write a brief description here
Write a brief description here
Write a brief description here
Write a brief description here
8. Prototype in a safe environment
How can we test this solution without risking patient safety or disrupting care?
Is the prototype ready for limited real-world exposure?
Before implementing a new workflow, it should be tested safely using low-risk prototyping. Simulation and role-play with realistic cases, supported by sandbox versions of digital tools, help identify workflow, usability, and safety issues early, allowing refinement before real patients and clinicians are affected.
0. Identify a problem of interest
What recurring issue is causing harm, inefficiency, or inequity in the system?
Is this problem important enough and common enough to warrant system-level learning?
You assemble a learning community with relevant stakeholders. The team wants to define the problem to be investigated. Find the problem statement best reflects an LHS mindset:
Correct!
Option 4
Option 3
Option 1
Option 2
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
This prematurely blames primary care, assuming a cause before any data is collected and analysed.
This places responsibility solely on patients and ignores broader system factors such as access to care, medication complexity, digital integration, or socio-economic barriers.
This focuses on the hospital’s internal capacity rather than asking why the ED is experiencing increased volume in the first place.
Primary care services are failing to prevent diabetes complications before they escalate to ED visits.
There has been a rise in ED presentations among patients with diabetes, and we need to understand system-level factors contributing to this trend.
Patients with diabetes are not managing their condition well, leading to unnecessary ED presentation.
The hospital needs better resources to handle the increasing number of diabetes-related ED visits.
This focuses on a system pattern exploration, not blame or assumptions.
Title
Title
Title
Title
Write a brief description here
Write a brief description here
Write a brief description here
Write a brief description here
11. Scale and embed change
How do we scale and sustain this change across the system?
What needs to be standardised, supported, or governed to make this routine practice?
You’re now ready to scale the solution after getting through governance and executive buy-in. What’s the best strategy to ensure it becomes embedded?
Option 2
Option 1
Option 4
Option 3
Correct!
Not the best choice.
Let's explore other options.
Try again.
Email everyone the new protocol and timelines for implementation
Implement the intervention and immediately move on to the next project to save time
Leave it to each clinician to decide whether to use it and how
Provide training, update workflows, assign champions, and monitor early adoption
Embedding change requires structured rollout and support.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Title
Title
Title
Title
Write a brief description here
Write a brief description here
Write a brief description here
Write a brief description here
10. Implement the intervention
Can this intervention be integrated into routine practice in a way that's sustainable?
Do we embed this as a standard organisational capability, or allow it to remain a one-off project outcome?
During early implementation, the project team notices that uptake varies across teams. They conduct interviews and find the following:
- The IT team reports delays integrating data into the EMR.
- Executive express strong support and have encouraged staff to trial the pathway.
It was found that strong leadership support and good workflow alignment were enablers of implementation, while time constraints and IT integration issues were barriers.7. Map and refine workflows
How would these solutions change day-to-day work for different system players?
Can the workflow changes realistically be integrated into existing practice?
The team is mapping the current workflow for diabetes follow-up, in order to see where their solution fits. What’s the most useful step?
Option 4
Option 2
Option 1
Option 3
Correct!
Not the best choice.
Let's explore other options.
Try again.
The workflow is obvious, so move straight to designing the intervention
To save time and resource, ask one clinician to describe their workflow
Map the workflow from each stakeholders perspective
Focus only on the ED process as this is where an intervention is required
Systems problems require multi-perspective workflow mapping. E.g. patients, ED staff, community care teams, pharmacy and EMR
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Title
Title
Title
Title
Write a brief description here
Write a brief description here
Write a brief description here
Write a brief description here
6. Brainstorm solutions
What changes could plausibly address the identified drivers?
Which solutions are feasible, acceptable, and aligned with system constraints?
During solution generation, which approach best aligns with team science and LHS principles?
Option 2
Option 4
Option 3
Option 1
Correct!
Let's explore other options.
Not the best choice.
Try again.
Choose the most cost-effective option
Bring together key stakeholders to co-design a solution
Let the IT department decide on a digital tool as this is their remit
Hold a workshop with clinical staff, to generate solutions
It is essential to consider the voices, expertise, lived experience and perspectives of all end users. Eg. clinicians, data analysts, IT, EMR, administration staff, and consumers to co-design ideas that will work for everyone.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Title
Title
Title
Title
Write a brief description here
Write a brief description here
Write a brief description here
Write a brief description here