Background Increasingly, efforts to advance health and well-being across whole organization, health systems, and communities include many related initiatives aligned to a common mission or goal. Too often, the work across a system suffers from ‘project-itis,’ lacking rigor in consistent design and learning systems to set up the work for real-time learning in support of success towards ultimate aims. To evaluate the work of QI implementation at project and organizational levels, we require systematic approaches to answer key learning questions and accelerate progress to our aims.

Objectives and Methods To identify and apply approaches to organizational learning we used in 2 case studies, one at the organization and one at the community level, to learn from for system-wide impact. The Cincinnati, Ohio All Children Thrive (ACT) Learning Network uses guiding principles to support system alignment. These include: focus on unassailable goals, amplify the voices of those with lived experience and apply rigorous improvement science across the many sectors that influence health. The Institute for Healthcare Improvement (IHI) organization-based learning system is guided by 3 key evaluation questions. We developed or deployed a set of tools, and drawn from established Improvement and Implementation Science frameworks, to undertake a regular review of project progress, learn from and act on the programmatic and contextual factors that were enabling or impeding progress towards the project goals, and understand the causal pathway for the results we observed.

Results and Conclusions We report on system design principles drawn from the two case examples. ACT’s learning system is applied at the neighborhood, city, and county level and has closed disparity gaps in a number of outcomes including preterm births, hospitalizations, and educational outcomes. IHI applied a novel framework for improvement research and evaluation across its portfolio of project work (more than 40 projects spanning a variety of content areas, project designs, and geographic settings). Systematic learning approach can be applied at organizational or community level to evaluate and learn from initiatives that are underway and to accelerate the path to achievement of organizational and community improvement goals.