A transformative translational change programme to introduce genomics into healthcare: a complexity and implementation science study protocol

Taylor, Natalie; Best, Stephanie; Martyn, Melissa; Long, Janet C.; North, Klaus; Braithwaite, Jeffrey; Gaff, Clara

doi:10.1136/bmjopen-2018-024681

Cited by 24 publications

(30 citation statements)

References 54 publications

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“…Learning from the ongoing clinical projects feeds into meeting the implementation objective of understanding service pathways and clinical processes. The aim is to co‐develop and co‐execute an implementation plan to facilitate adoption of genomics in clinical practice across Australia in a way that is cost‐effective, clinically useful, and feasible …”

Section: Introductionmentioning

confidence: 99%

The time has come: Embedded implementation research for health care improvement

Churruca

Ludlow

Taylor

et al. 2019

Evaluation Clinical Practice

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111

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Rationale, aims, and objectives: The field of implementation science has developed in response to slow and inconsistent translation of evidence into practice. Despite utilizing increasingly sophisticated approaches to implementation, including applying a complexity science lens and conducting realist evaluations, challenges remain to getting the kinds of outcomes hoped for by implementation efforts. These include gaining access and buy-in from those implementing the change and accounting for the influence of local context. One emerging approach to address these challenges is embedded implementation research-a collaborative, adaptive approach to improvement. It involves researchers and implementers working together in situ from the outset of, and throughout, an implementation project. Both groups can benefit from the collaboration: it increases the rigor of evaluation, provides opportunities to improve the intervention through direct feedback, and promotes better on-the-ground understanding of the change process. We aimed to examine the potential benefits, and some of the challenges, of increased embeddedness. Method:We performed a multi-case analysis of implementation research projects that varied by degree of embeddedness.Results: Embedded implementation research may offer a range of advantages over dichotomized research-practice designs, including better understanding of local context and direct feedback to improve the implementation along the way. We present a model that spans four approaches: dichotomized research-practice, collaborative linking-up, partially-embedded, and deep immersion. Conclusion: Embedded implementation research approaches hold promise in comparison to traditional dichotomized-research practice designs, where the research is external to the implementation and conducts a summative evaluation. We are only beginning to understand how such partnerships operate in practice and what makes them successful. Our analysis suggests the time has come to consider such approaches. Box 1 : Terminology Action research (or participatory action research): Researchers engage health professionals in the design and implementation of research,working with them as opposed to externally studying them. 42,43 Co-located: The researcher is physically located within the setting of the implementation initiative to conduct collaborative research with implementers and end-users. 44 Co-creation: See Co-production of knowledge. 10Co-production of knowledge: Concerns the production and spread of knowledge in the context it will be used through the collaboration of relevant stakeholders. Co-production may occur at the design, implementation, or evaluation stages of a program (co-design, co-evaluation, and co-implementation, respectively). 19,22 Engaged scholarship: Research conducted in collaboration with stakeholders, eg, implementers and practitioners, to gain insight into the context and phenomenon being studied. 45 Insider academic research: Research carried out by someone employed within the organization under study. ...

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Section: Introductionmentioning

confidence: 99%

The time has come: Embedded implementation research for health care improvement

Churruca

Ludlow

Taylor

et al. 2019

Evaluation Clinical Practice

Self Cite

111

View full text Add to dashboard Cite

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“…laboratory scientists and commonly a genetic counsellor. Potential participants were identified by an expert reference group that consisted of five people with genetic/genomic, clinical, laboratory and implementation science knowledge and experience [ 18 ]. Everyone identified was invited to interview via email (SB).…”

Section: Methodsmentioning

confidence: 99%

Investigating the Adoption of Clinical Genomics in Australia. An Implementation Science Case Study

Best

Long

Gaff

et al. 2021

Genes

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Despite the overwhelming interest in clinical genomics, uptake has been slow. Implementation science offers a systematic approach to reveal pathways to adoption and a theory informed approach to addressing barriers presented. Using case study methodology, we undertook 16 in-depth interviews with nongenetic medical specialists to identify barriers and enablers to the uptake of clinical genomics. Data collection and analysis was guided by two evidence-based behaviour change models: the Theoretical Domains Framework (TDF), and the Capability, Opportunity Motivation Behaviour model (COM-B). Our findings revealed the use of implementation science not only provided a theoretical structure to frame the study but also facilitated uncovering of traditionally difficult to access responses from participants, e.g., “safety in feeling vulnerable” (TDF code emotion/COM-B code motivation). The most challenging phase for participants was ensuring appropriate patients were offered genomic testing. There were several consistent TDF codes: professional identity, social influences, and environmental context and resources and COM-B codes opportunity and motivation, with others varying along the patient journey. We conclude that implementation science methods can maximise the value created by the exploration of factors affecting the uptake of clinical genomics to ensure future interventions are designed to meet the needs of novice nongenetic medical specialists.

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“…An overview is provided here, and methodological detail, including interview schedule content, can be found elsewhere. 31 To gather data on leadership, a deductive qualitative approach was adopted using secondary analysis of semistructured interviews.…”

Section: Methodsmentioning

confidence: 99%

The leadership behaviors needed to implement clinical genomics at scale: a qualitative study

Best

Stark

Brown

et al. 2020

Genetics in Medicine

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Purpose: To investigate leadership in clinical genomics and identify likely implications of different leadership approaches for future implementation of clinical genomics. Methods: We undertook 37 interviews in a cross-sectional qualitative study examining implementation of clinical genomics in Australia. Participants were either nongenetic medical specialists working with genomic initiatives (e.g., immunologists, nephrologists) or working at a service/organizational level (e.g., department heads, chief medical officers). We identified participants as genomic migrants (long-established practitioners) and genomic natives (those medical specialists coming into independent practice with genomic technology in situ). Data were analyzed deductively with reference to leadership approach. Results: Leadership approaches were often blended or reported to iteratively support development of another. There was concern at both the absence or the excess of entrepreneurial leadership (i.e., risk-taking). Conclusion: Entrepreneurial leadership is needed to promote innovativeness, risk-taking, and proactivity, essential in these early stages of clinical genomics. Shared decision-making is required from a wide range of clinicians, calling for both clinical and distributed leadership. Sharing leadership, and the potential loss of positional status from formal senior positions, may prove challenging to genomics "migrants," who are essential for nurturing genomic "natives." Clinicians will need support from their organizations and professional bodies to manage the transition.

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A transformative translational change programme to introduce genomics into healthcare: a complexity and implementation science study protocol

Cited by 24 publications

References 54 publications

The time has come: Embedded implementation research for health care improvement

The time has come: Embedded implementation research for health care improvement

Investigating the Adoption of Clinical Genomics in Australia. An Implementation Science Case Study

The leadership behaviors needed to implement clinical genomics at scale: a qualitative study

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