Abstract
BackgroundAdopting clinical genomics represents a major systems-level intervention requiring diverse expertise and collective learning. The Australian Genomic Health Alliance (Australian Genomics) is strategically linking members and partner organisations to lead the integration of genomic medicine into healthcare across Australia. This study aimed to map and analyse interconnections between members—a key feature of complexity—to capture the collaborations among the genomic community, document learning, assess Australian Genomics’ influence and identify key players.MethodsAn online, whole network study collected relational data from members asking them about two time points: baseline, before Australian Genomics started operation in 2016 and current in 2018. Likert style questions assessed the influence of various sources of knowledge on the respondents’ genomic practice. A secure link to the online questionnaire was distributed to all members of Australian Genomics during May 2018. Social network data was analysed and visually constructed using Gephi 0.9.2 software, and Likert questions were analysed using chi-squared computations in SPSS. The project was given ethical approval.ResultsResponse rate was 57.81% (222/384). The genomic learning community within Australian Genomics was constructed from the responses of participants. There was a growth in ties from pre-2016 (2925 ties) to 2018 (6381 ties) and an increase in density (0.020 to 0.043) suggesting the strong influence of Australian Genomics in creating this community. Respondents nominated 355 collaborative partners from 24 different countries outside of Australia and 328 partners from within Australia but outside the alliance. Key players were the Australian Genomics Manager, two clinical geneticists and four Operational staff members. Most influential sources of learning were hands on learning, shared decision making, journal articles and conference presentations in contrast to formal courses.ConclusionsThe successful implementation of clinical genomics requires the engagement of multidisciplinary teams across a range of conditions and expertise. Australian Genomics is shown to be facilitating this collaborative process by strategically building a genomic learning community. We demonstrate the importance of social processes in building complex networks as respondents name “hands on learning” and “making group decisions” the most potent influences of their genomic practice. This has implications for genomic implementation, education and work force strategies.
Highlights
Adopting clinical genomics represents a major systems-level intervention requiring diverse expertise and collective learning
The key relationship of interest was framed around “who is part of your genomic learning community / knowledge exchange network?” The expert panel defined the boundaries of the network, i.e., the final list of invited participants who were considered members of Australian Genomics
Participants Invitations were emailed to 384 members of Australian Genomics
Summary
Adopting clinical genomics represents a major systems-level intervention requiring diverse expertise and collective learning. A useful approach to understanding across-the-board adoption of new health technologies is to view healthcare as a complex adaptive system (CAS) [1, 2]. This term is used to describe a collection of agents (individuals) that interact dynamically and who may, as a result, learn, adapt and reorganise themselves without substantial outside direction. Hallmark characteristics of CASs are the multiple agents whose actions are not always predictable and whose relationships and interdependencies change the context in which they work [2, 6] Over time, these connections and influences can give rise to a tipping point, with new emergent behaviours, and self-organisation into new team configurations [7, 8].
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