Abstract
BackgroundClinical genomics represents a paradigm shifting change to health service delivery and practice across many conditions and life-stages. Introducing this complex technology into an already complex health system is a significant challenge that cannot be managed in a reductionist way. To build robust and sustainable, high quality delivery systems we need to step back and view the interconnected landscape of policymakers, funders, managers, multidisciplinary teams of clinicians, patients and their families, and health care, research, education, and philanthropic institutions as a dynamic whole. This study holistically mapped the landscape of clinical genomics within Australia by developing a complex graphic: a rich picture. Using complex systems theory, we then identified key features, challenges and leverage points of implementing clinical genomics.MethodsWe used a multi-stage, exploratory, qualitative approach. We extracted data from grey literature, empirical literature, and data collected by the Australian Genomic Health Alliance. Nine key informants working in clinical genomics critiqued early drafts of the picture, and validated the final version.ResultsThe final graphic depicts 24 stakeholder groups relevant to implementation of genomics into Australia. Clinical genomics lies at the intersection of four nested systems, with interplay between government, professional bodies and patient advocacy groups. Barriers and uncertainties are also shown. Analysis using complexity theory showed far-reaching interdependencies around funding, and identified unintended consequences.ConclusionThe rich picture of the clinical genomic landscape in Australia is the first to show key stakeholders, agencies and processes and their interdependencies. Participants who critiqued our results were instantly intrigued and engaged by the graphics, searching for their place in the whole and often commenting on insights they gained from seeing the influences and impacts of other stakeholder groups on their own work. Funding patterns showed unintended consequences of increased burdens for clinicians and inequity of access for patients. Showing the system as a dynamic whole is the only way to understand key drivers and barriers to largescale interventions. Trial Registration: Not applicable
Highlights
Clinical genomics represents a paradigm shifting change to health service delivery and practice across many conditions and life-stages
The aim of this study was to develop a ‘rich picture’ through collection and analysis of a range of data to map the landscape of clinical genomics within Australia, allowing a more holistic evaluation of the translational activities of Australian Genomics
Starting with a list of stakeholders and issues known to our team from previous work in clinical genomics [16, 19, 25, 26], we constructed the first iteration of the rich picture to illustrate the interplay of factors around the introduction of clinical genomics into healthcare in Australia
Summary
Clinical genomics represents a paradigm shifting change to health service delivery and practice across many conditions and life-stages Introducing this complex technology into an already complex health system is a significant challenge that cannot be managed in a reductionist way. CASs are characterised by multiple, semi-autonomous agents that interact, have interdependencies and tend to selforganise; these systems display emergent behaviour, and have non-linear, unpredictable outcomes Health systems fit this model well with their large numbers of interacting health professionals, patients and family members, nested departments, specialties and services, self-organising teams, and social processes. In such a system, focussing on the individual parts in isolation will not lead to an understanding of the system as a whole and is inadequate to address challenges that arise [4]. Understanding these system features by using a complexity theory lens will increase our ability to intervene and leverage improvements [14, 15]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
