Creating a purpose-driven learning and improving health system: The Johns Hopkins Medicine quality and safety experience.

Health care has often relied on independent silos of medical research to drive progress and innovation. However, this approach does not adequately address the complexities and opportunities within the modern health care environment. We posit that creating a learning and improving health system that is purpose-driven will ultimately lead the next transformation in health care. We share the experience within Johns Hopkins Medicine that established a learning and improving health system in quality and safety. The system is built around a clear and compelling patient-centered purpose and leverages a fractal framework that provides horizontal links for peer learning and vertical links for accountability. It dismantles traditional research and clinical silos and combines basic and applied research with health system operations. As a result, the system aligns the goals and strengths of a diverse set of stakeholders including clinicians, patients, researchers, and administrators toward a common goal.