How Calgary ICUs Became a Living Lab from the Ground Up
Walk into any intensive care unit (ICU) and you’re met with a storm of sounds and screens. Monitors beep. Alarms pulse. Charts pile up. Every number matters, but together they can feel like a static record of what already happened, not a guide for what to do next. But the Calgary Department of Critical Care Medicine is turning those numbers into something new. It’s a living laboratory where data doesn’t just describe care, it drives it.
Dr. Selena Au, associate professor in the Department of Critical Care Medicine at the University of Calgary, and the ICU QI DASH team (Improving Care in the ICU through a Physician Practice Metrics Dashboard and QI Rounds Co-Design) is rethinking the use of data in the ICU. Instead of being buried in data, they are building a system that learns from it, empowering clinicians to lead quality improvement from within.
What they are building isn’t just a dashboard; it is a learning health system with up-to-date clinical data, where practice reflection and quality improvement are integrated into everyday practice.
Listening first: Letting frontline teams define what matters
Dr. Au’s team started with a commitment to co-design by asking intensivists and ICU staff to identify clinical practices that matter most to them. Through a consensus-building process, frontline providers sifted through more than a hundred possible measures ranking them by relevance, data availability, and true clinical impact. Working alongside data analysts they transformed this data into clinically meaningful metrics that can be visualized, interpreted and actioned.
“The metrics were a complete black box at the start,” Dr. Au says. “They emerged directly from the frontline team. That was the whole point: to measure what we believed was essential to improving care." When the people who use the data get to define it, something powerful happens: the data becomes theirs.
Building dashboards, one honest conversation at a time
Once the team agreed on the metrics, they faced a new challenge: how to make the data usable? On a regular basis, the team would meet and gather for “Learning QI Rounds” to review prototype dashboards. A space for debate, scepticism, and real talk.
“You have to be ready for someone to say, ‘This metric makes no sense,’” Dr. Au says. “Or, ‘Why on earth would you show it like that?’ Our data analysts are in the room, hearing it live.” These rounds have become a safe testing ground where ideas are debated, rebuilt, and improved together. What starts as a chart on a slide slowly evolves into something the team trusts and uses.
The Physician Learning Program (PLP) has been an important partner in this work. Together with AHS eCritical, PLP supported the development of the physician practice metrics dashboard that brings real time data into those QI conversations. The first version, focused on post cardiac arrest temperature management, showed how seeing one’s own data could spark reflection and action. Since then, new measures such as extubation failure and readmission have been added, giving critical care teams a clearer view of where care algins with evidence and where it can improve.
The initiative has been highly valued by participants, with 80% of physicians reporting that the dashboards helped them compare their practices to evidence-based standards, identify gaps in care, and benchmark performance against peers.
The ICU Is a team sport
It did not take long for the group to realize that data built only for doctors was never going to work. “The ICU runs on collaboration,” Dr. Au explains. “Every decision touches multiple professions from how a drug is prescribed to how it’s administered or how a patient is mobilized.” So, the project expanded to include nurses, respiratory therapists, physiotherapists, and other allied health professionals. Each group gained visibility into data that reflected their own work. Not for comparison. Not for judgment. But for learning together. That’s what co-design looks like in practice not just collaboration, but shared ownership of patient outcomes.
The real secret: A protected space for honest dialogue
Behind all the dashboards and data, there is something quieter that keeps the engine running like protected time and space for people to talk openly. “It’s our secret ingredient” Dr. Au says. “Our leadership prioritizes this by making time for reflection. It’s not just meetings. It’s a safe container for hard conversations.”
It’s how theory becomes action and why people keep showing up to the table. A system that learns because its people do. In the end, Calgary’s ICU project is proof that a Learning Health System isn’t built from software or spreadsheets alone - it’s built from relationships. By trusting frontline teams, encouraging conversations, and making learning part of everyday care, they have created something rare: a culture that grows stronger with every conversation and data point.
Dr. Au also highlights the collaborative effort behind this work, recognizing Dr. Dan Zuege as her partner in the grant application, Simon Fukada as the lead eCritical analyst, and Sarah Seymour and Katelynn Crick as the project managers most involved at PLP.