Standardizing variation: Scaling up clinical genomics in Australia

Area of Science:

• Genomic Medicine
• Healthcare Implementation Science

Background:

• Clinical genomics integration necessitates collaboration among physicians, lab scientists, and genetic professionals.
• Scaling genomic medicine requires understanding processes from the perspective of non-genetic physicians new to the field.

Purpose of the Study:

• To identify adaptable components within clinical genomics processes for successful scaling.
• To understand the process of clinical genomics implementation from the viewpoint of non-genetic physicians.

Main Methods:

• Utilized semistructured interviews guided by the Theoretical Domains Framework with 16 non-genetic physicians.
• Employed annotated process mapping reflecting the patient journey (7 steps) to capture implementation details.
• Synthesized individual process maps into an overview map and analyzed interview data using the Theoretical Domains Framework.

Main Results:

• Identified 16 common steps across specialties and locations in clinical genomics implementation.
• Discovered variations in 9 specific steps, highlighting areas for potential standardization.
• Generated 1 overview and 10 individual process maps from participating physicians.

Conclusions:

• Process mapping effectively identifies steps amenable to variation during the scale-up of complex interventions.
• Adaptation to local context and evolving factors is crucial for the ongoing implementation and sustainability of clinical genomics.
• Standardization potential exists across key steps in clinical genomics workflows.