{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T08:24:51Z","timestamp":1787041491802,"version":"build-2736575974"},"reference-count":56,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100022760","name":"Trillium Health Partners Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100022760","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Learning Health Systems"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Health systems around the world are investing in learning health system (LHS) infrastructure to strengthen their capacity to adapt, improve, and respond in real time. While prior work has focused on technical infrastructure, less is known about the conditions that enable learning to happen as envisioned. We aimed to address this knowledge gap by developing a multi\u2010level, empirically grounded theory for operationalizing organizational attributes and leadership practices that influence learning in LHS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We adopted an iterative, theory\u2010informed qualitative approach inspired by realist evaluation principles. Drawing on organizational and LHS literature, we developed an initial program theory hypothesizing key antecedents of organizational learning and conducted semi\u2010structured interviews with formal leaders in a large community hospital using a \u201cteacher\u2010learner cycle\u201d to test and refine the initial program theory.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Based on interviews with 12 formal leaders, we developed a mid\u2010range program theory outlining how structural, leadership, and cultural factors interact to create (or impede) the conditions for organizational learning in LHS. Resource investment, organizational governance, shared organizational identity, and leadership approaches emerged as key factors. These factors influence both the relational dynamics and execution dynamics that drive how work is done, determining whether the culture is characterized by learning catalysts or inertial loops.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Leadership practices shape the cultural conditions that enable or stall system\u2010level learning in LHS. While structural supports matter, they do not create the conditions for learning without leadership practices that reinforce clarity, connection, and curiosity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lrh2.70082","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T07:45:13Z","timestamp":1777535113000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Supporting Cultural and Learning Enablers for a Learning Health System (\n                    <scp>SCALE<\/scp>\n                    ): A Program Theory Approach"],"prefix":"10.1002","volume":"10","author":[{"given":"Laura","family":"Desveaux","sequence":"first","affiliation":[{"name":"Institute for Better Health Trillium Health Partners  Mississauga Ontario Canada"},{"name":"Institute of Health Policy, Management and Evaluation University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruoxi","family":"Wang","sequence":"additional","affiliation":[{"name":"Institute for Better Health Trillium Health Partners  Mississauga Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayshree","family":"Joshi","sequence":"additional","affiliation":[{"name":"Trillium Health Partners  Mississauga Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marissa","family":"Bird","sequence":"additional","affiliation":[{"name":"Institute for Better Health Trillium Health Partners  Mississauga Ontario Canada"},{"name":"Institute of Health Policy, Management and Evaluation University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,30]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.2471\/B09387"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.5465\/amj.2016.4007"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/1048291120974358"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2013.0714"},{"key":"e_1_2_12_6_1","first-page":"160","article-title":"APOCALYPSE NO: Population Aging and the Future of Health Care Systems","volume":"20","author":"Evans R. 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