The Improving Renal Outcomes Collaborative (IROC), a Learning Health System, was started in 2016 with 15 pediatric kidney transplant programs and a year-long design session rooted in stakeholder ethnographies. Since, IROC has more than doubled in size and is utilizing QI methodologies to improve the health, longevity, and quality of life for children with kidney disease. The presentation will be an overview of how IROC got started, its roots in co-production, achievements in the last five years, and lessons learned so it can continue to grow and thrive moving forward. 

• Understand the IROC ethnography process and outputs and its importance to the design phase. 

• Review key components of IROC's growth and operations in its first five years 

• Review IROC's strategic clinical outcome improvement priorities, specifically cardiovascular disease and rejection, and understand the successes and lessons learned while implementing each 

• Discuss how IROCs achievements and challenges in the first five years will influence its operations and strategic direction in the next five years