• Bradley N Doebbeling and Mindy E Flanagan.
• VA Health Services Research and Development Center on Implementing Evidence-based Practice, Roudebush Veterans Affairs Medical Center, Indianapolis, IN, USA. bdoebbel@gmail.com
• Med Care. 2011 Dec 1;49 Suppl:S59-64.

BackgroundU.S. healthcare requires major redesign of its delivery systems, finances, and incentives. Healthcare operations, leadership, and payors are increasingly recognizing the need for community-business-research partnerships to transform healthcare. New models of continuous learning, research, and development should help focus and sustain redesign efforts.PurposeThis study summarizes suggested strategies for transformational change in healthcare and identifies needed areas for research to inform, spread, and sustain transformational change.MethodsWe developed these recommendations based on a series of review papers, invited expert discussion, and a subsequent review in the context of a health system transformation research conference (The Regenstrief Biennial Research Conference). The multidisciplinary audience included health systems researchers, clinicians, informaticians, social and engineering scientists, and operational and business leaders.FindingsConference participants and literature reviews identified key strategies for system redesign with the following themes: using the framework of complex adaptive systems; fostering organizational redesign; developing appropriate performance measures and incentives; creating continuous learning organizations; and integrating health information, technology, and communication into practice. Sustained investment in research and development in these areas is crucial.ConclusionsMultiple issues influence the likelihood that healthcare leaders will make transformational changes in their healthcare systems. Healthcare leaders, clinicians, researchers, journals, and academic institutions, in partnership with payors, government and multiple other stakeholders, should apply the recommendations relevant to their own setting to redesign healthcare delivery, improve cognitive support, and sustain transformation. Fostering further research investments in these areas will increase the impact of transformation on the health and healthcare of the public.

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