Unlocking the potential of genomics: a co-designed toolkit for hospital implementation and governance

Genomics is increasingly part of routine clinical care. However, hospital leaders face a range of organisational challenges in implementing safe, effective genomic care including: insufficient resources, rapidly evolving practices, gaps in genomic literacy, data infrastructure demands and limited governance frameworks. Good clinical governance can overcome these barriers by aligning leadership, resources, workforce development, monitoring and accountability to enable structured, reliable adoption.

To describe our iterative co-design processes and final outputs in developing a resource for hospital executives. This toolkit resource applies clinical governance principles to support organisation-wide implementation and oversight of evidence-based genomic care in hospitals.

A co-design implementation science-informed approach was adopted, following the updated Medical Research Council guidance for complex interventions. This involved 85 individuals from 14 healthcare organisations across Victoria (Australia) participating in a concept testing workshop, usability testing and content advisory groups.

A maturity self-assessment tool was initially designed. Interested organisations could map their current state of maturity in the identified domains. The tool was assessed for feasibility, usability and potential value to stakeholders and revised through three major co-design steps. The evaluation of feedback and learnings led to the decision to transition the self-assessment prototype to the Genomics and Your Hospital Toolkit (the 'toolkit'). This comprised seven key action domains and a suite of resources designed for any hospital undertaking genomic care, irrespective of their maturity. The key action areas are as follows, with supporting resources developed for each: (1) form a genomics leadership group; (2) define models of care; (3) understand and mitigate risks; (4) check workforce skills and support; (5) support and monitor quality and value; (6) review new genomic practice and (7) involve consumers in genomic medicine services.

The toolkit is designed to lower the barriers to hospital executives embedding high-quality genomic care across their organisation. Although developed specifically for genomics, the toolkit addresses common challenges in the implementation and oversight of care that includes large-scale emerging technologies intended to make individual care more precise.