Learning in the health care enterprise

INTRODUCTION: The overall enterprise of health care delivery is considered. The 4 levels of the enterprise include clinical practices, processes that provide capabilities and information, structure that includes the business entities involved, and ecosystem that includes Centers for Medicare and Medicaid Services and Congress, as well as societal values and norms. It is argued that the enterprise of health care delivery needs to be transformed to enable high‐quality, affordable care for everyone. DISCUSSION: The constructs of enterprise transformation and organizational learning are reviewed. The distinction of single‐loop versus double‐loop learning is discussed and illustrated for all levels of the health care delivery enterprise. Three health care examples are used to elaborate this distinction—cancer, population health, and health IT. Four strategies are outlined that the health care delivery enterprise can use to more effectively learn at all levels of the enterprise. CONCLUSIONS: This overall line of reasoning suggests several important research issues. The health care delivery enterprise involves much more than treating disease and paying for it. We need to improve our methods and tools for addressing the overall enterprise. Research is also needed on better means for portraying consequences of decisions to the full range of stakeholders in the enterprise. In general, the overall goal should be a healthy, educated, and productive population that is competitive in the global marketplace. We need to better understand the available levers for achieving this goal and how to best portray the intricacies of the overall enterprise to motivate those who can pull these levers to do so.