Factors influencing organizational adoption and implementation of clinical genetic services

Abstract

Purpose:We sought to identify characteristics of genetic services that facilitate or hinder adoption. Methods:We conducted semi-structured key informant interviews in five clinical specialties (primary care, medical oncology, neurology, cardiology, pathology/laboratory medicine) within 13 Veterans Administration facilities.Results: Genetic services (defined as genetic testing and consultation) were not typically characterized by informants (n = 64) as advantageous for their facilities or their patients; compatible with organizational norms of low cost and high clinical impact; or applicable to patient populations or norms of clinical care. Furthermore, genetic services had not been systematically adopted in most facilities because of their complexity: knowledge of and expertise on genetic testing was limited, and organizational barriers to utilization of genetic services were formidable. The few facilities that had some success with implementation of genetic services had knowledgeable clinicians interested in developing services and organizational-level facilitators such as accessible genetic test-ordering processes.Conclusion: Adoption and implementation of genetic services will require a multilevel effort that includes education of providers and administrators, opportunities for observing the benefits of genetic medicine, strategies for reducing the complexity of genomic medicine, expanded strategies for accessing genetics expertise and streamlining utilization, and resources dedicated to assessing the value of genetic information for the outcomes that matter to health-care organizations.

Assessing multilevel determinants of adoption and implementation of genomic medicine: an organizational mixed-methods approach

“…2 Because of complex patient-, provider-, and system-level barriers, however, the adoption and implementation of evidence-based genomic medicine has been slow in health-care settings. [3][4][5][6][7][8] In response to this limited integration of genetics and genomics into clinical care, translation research has been widely called for, [9][10][11][12] with a recent emphasis on the need for multilevel interventions 13 targeting implementation challenges across three or more levels of contextual influence 14 on genetic health-care delivery. Levels of contextual influence can include patients, their families, and social supports; health-care providers; health-care organizations; and the state and national policy environment.…”

Developing a framework for implementation of genetic services: learning from examples of testing for monogenic forms of common diseases

“…Furthermore, Battista et al (2012) expressed the need for reconfiguration of professional roles and responsibilities and a lack of preparedness for enhanced sharing of expertise between professionals in first-, second-, and third-line medical care for optimal integration of genetic services into the health-care system. Moreover, a more recent study by Hamilton et al (2013) identified overlapping characteristics of genetic services that hinder or facilitate adoption within health-care organizations. In our study, it also became clear that often, diffusion and dissemination of new practices (when broadening and scaling up) provide specific challenges.…”

“…In our study, it also became clear that often, diffusion and dissemination of new practices (when broadening and scaling up) provide specific challenges. Referring to the steps described by Hamilton et al (2013) (reflecting the processes needed for broadening, deepening, and scaling up), it seems that making early adopters visible, creating "slack for change" (by creating a sense of urgency among the relevant stakeholder) and enabling reinvention are not always receiving the required attention. This may be due to the fact that change agents are more focused on trying to obtain proof of principle (deepening) than on having a long-term vision.…”

“…Specifically, for relatively rare genetic disorders, this is very relevant, since in many cases, it may not be cost-effective to only provide local services. It is therefore relevant to acknowledge that "diffusion of innovation" as previously referred to (Hamilton et al 2013;Lomas 1993) might not be the optimal term when discussing efficient implementation of genetic services in mainstream medicine, since this requires a more active process. "Transition management" might be a term that better describes this process (Loorbach 2007;van Raak 2010).…”

“…Although, e.g., seven steps to be undertaken for strategic implementation of innovations in health care have been applied to clinical genetic services recently by Hamilton et al, little practical further guidance exists for the planning and execution of such transition processes related to genetic health services (Bennett et al 2010;Berwick 2003;Hamilton et al 2013;Manolio et al 2013;Rogowski et al 2009).…”