Advancing the evaluation of learning health systems: a commentary

Around the world, health systems and governments are investing in Learning Health Systems (LHS) to accelerate the pace of science and improve services. These LHS are designed to continuously assess system performance, so as a practice is implemented, it can be evaluated and improved upon. However, evaluation of LHS is, as yet, underdeveloped in both theory and practice, particularly regarding the role of iteration as a core principle. This commentary is intended for LHS designers, evaluators, and funders, highlighting how integrating iterative, values-driven evaluation approaches early in LHS design and implementation can enhance learning and equity. It introduces “Soft Systems Methodology” along with values frameworks from Information Systems Development, which are then integrated into exemplar evaluation frameworks of LHS. Soft Systems Methodology centers iteration and integrates the importance of different interest-holders’ worldviews and values. It targets “problematical situations” which evolve over time and have many possible solutions based on different worldviews and values. Integrating Soft Systems Methodology into LHS development supports emerging matrix-based conceptualizations of LHS and helps maintain their core philosophy of continuous improvement and iteration.