Relational work in implementation: a qualitative analysis of intra- and inter- professional strategies leveraged in...

Relationships are foundational to successful implementation of innovations in healthcare. In genomic medicine, multidisciplinary teams with good communication are most effective to provide safe genomic care; however, working together could be challenging due to the distinct work culture, worldviews, and clinical approaches held by different professional groups. In this paper, we explored the various strategies used to build relationships and foster collaboration as part of a Change program that supported the use of genomic testing and counselling in specialty areas.

Qualitative interviews were conducted with 36 participants across 3 professional categories (genetic counsellors, medical specialists, and nurses/allied health workers) to ask about their experiences working together in innovative models of genomic care across 7 clinical specialties. Data analysis was conducted through a two-staged inductive and deductive coding process: firstly to identify the categories based on the attributes of the Relational Theory and then coded against the Theoretical Model for Trusting Relationships and Implementation (the 'Model').

Eight out of nine strategies to build/strengthen relationships described in the 'Model' were identified in the interview data. They included three technical strategies and five relational strategies. The inter-connections were present between relational and technical strategies, as well as within the relational category, whereby some served to reinforce one another. Two additional strategies emerged from the interview data but were not included within the 'Model,' including: negotiating boundary work and accepting differences used at inter-professional level. Specifically, genetic counsellors either reconstructed the professional boundary by taking over tasks beyond their role or adopted a boundary-preserving strategy to balance the social order within the team.

Our study highlights how relationship-building strategies can be leveraged in genomic multidisciplinary teams and can inform decisions about creating conditions that promote positive relationships and relational competence, ultimately leading to successful implementation of innovations into organisations/systems.