Elevating transformation: Citizen-guided and evidence-backed action

Too often, conventional approaches to health system transformation falter because we fail to ask critical questions: How do citizens envision improving their healthcare experience? And what does the best evidence reveal about designing and delivering effective systems of care? In this interactive dialogue, we heard from citizen partners, system operators, and evidence-support partners – in effect, the perspectives that comprise the ‘three-legged stool’ as defined in the Learning Health System action framework. The following are some of the key highlights that emerged from this discussion:

 

Citizens as drivers of change: True transformation begins when patients and citizens are not only consulted but engaged as co-leaders in shaping care systems. Several panelists emphasized the need to embed patient voices in strategic decision-making, planning, and governance—not as one-off contributors, but as continuous partners. As Joss Reimer noted, this creates a system that better serves both patients and providers, bringing meaning and value into care.

 

Redefining evidence support systems: Kerry Waddell highlighted the critical features of strong evidence support systems: they must be responsive (to timing and to the types of evidence needed), networked (across organizations and globally), and contextualized (tailored to local realities). These systems act as a bridge between research and real-world decision-making and are most effective when the values and preferences of those most impacted are at the forefront.

 

Equity must be embedded: Equity was a cross-cutting theme, described not as a siloed principle but as one integrated throughout the entire LHS framework. Panelists called for structural changes - from admissions and hiring to patient engagement and leadership development - that move beyond representation to system-level inclusion and accountability.

 

Collaboration and learning across boundaries: Organizational leader Heather Bullock discussed the challenges of operationalizing the LHS model, particularly in resource-constrained environments. She emphasized the importance of partnerships, shared capacity, and a learning mindset, especially in moving beyond reactive, “firefighting” approaches to health care management.

 

Reframing investment priorities: Speakers highlighted the imbalance in health care spending, particularly the overinvestment in acute care. They advocated for evidence (both research and experiential) to drive more upstream, long-term investments, particularly in primary care, mental health, and public health.

 

The power of storytelling: Throughout the session, storytelling emerged as a critical tool for change. Whether used to explain the value of the LHS, communicate the impact of inequities, or bridge gaps across silos, stories were seen as central to making transformation tangible and urgent for decision-makers and communities alike.

 

The session concluded with a call to action: to strengthen partnerships, embed equity, and move beyond traditional silos in how we generate, use, and act on evidence. As citizen leader Maureen Smith reminded the room, "The people in this room hold power—you can be allies and champions."