Genomics translational activities

Project Members - Macquarie University

Janet Long - Senior Research Fellow janet.long@mq.edu.au

Kate Churruca - Research Fellow kate.churruca@mq.edu.au

Louise Ellis - Research Fellow louise.ellis@mq.edu.au

Robyn Clay-Williams - Associate Professor robyn.clay-williams@mq.edu.au

Peter Hibbert - Associate Professor peter.hibbert@mq.edu.au

Jeffrey Braithwaite - Professor and Director jeffrey.braithwaite@mq.edu.au

Project Main Description

Our health system is increasingly complex; constantly changing and adapting. Finding ways to understand that complexity in a holistic manner (avoiding the reductionist temptation to study single processes in isolation) is imperative if we are to understand how things work and how they can work better.

This project will increase our ability to understand complexity and network capacities by studying the Australian Genomics Health Alliance (AGHA) as an example of a complex adaptive system. The AGHA was funded to oversee and facilitate the introduction of genomic medicine into Australian health settings. This nationwide alliance of clinicians, scientists, researchers, and consumers across varied sites, conditions and contexts is sufficiently complex, yet bounded enough, to permit a holistic and dynamic exploration with the aim of documenting interactions, productivity, and ways to enhance systems performance. We will examine the AGHA for the key defining features of a complex adaptive system: semi-autonomous agents, dynamic, non-linear interactions, emergent behaviours and self-organisation. We will use a mixed method, longitudinal design to construct our picture of the AGHA.

Background

The AGHA is bringing together a wide range of partner organisations to lead the integration of genomic medicine into healthcare across Australia. Genomic sequencing is an extremely complex process to introduce into already complex clinical settings and health delivery systems that are already under substantial pressure. Challenges include: structural (e.g. changed laboratory set ups, changed membership and process of multidisciplinary teams), financial (e.g. costs of the sequencing, workforce development issues), cognitive (e.g. understanding the complexity of curation and limitations of genomic testing), and cultural (e.g. medical paradigms and ways of working compared to genetic counselling).

Aims

The overarching aim of this two-year project is to describe the AGHA as a complex adaptive system using Rich Pictures, dynamic modelling and social network analyses to show organisations, individual agents, relationships, emergent features and behaviours, components (e.g., technology), key drivers, and contextual influences and how they inter-relate.

Working Paper

CHRIS Working paper #102

Leveraging features of complexity to drive implementation: a critical review of studies from clinical genomics
Janet C Long, Kate Churruca, Louise A Ellis, Hossai Gul, Elise McPherson, Stephanie Best, Aleksandra Olekahns, Jeffrey Braithwaite

Publications

1. Long JC, Gaff C and Clay C. (2022). Deeble Perspectives Brief 20. Transforming the genomics workforce to sustain high value care. Australian Healthcare and Hospitals Association, Canberra, Australia.
2. Long JC, Pomare C, Best S, Boughtwood T, North Kathryn, Ellis LA, Churruca K, Braithwaite J  Building a learning community of Australian clinical genomics: a social network study of the Australian Genomic Health Alliance. BMC Medicine 2019; Feb 22
3. Braithwaite J, Clay-Williams R, Nugus P, Plumb J. Health care as a complex adaptive system. In: Wears RL, Hollnagel E, Braithwaite J, eds. Resilient Health Care: Ashgate Publishing, 2015.
4. Sterman JD. Learning from evidence in a complex world. 2006;96(3):505-14
5. Wasserman S, Faust K. Social network analysis. Cambridge: Cambridge University Press, 1994.
6. Watts DJ, Strogatz SH. Collective dynamics of 'small-world' networks. Nature 1998;393(6684):440-42
7. Cunningham FC, Ranmuthugala G, Plumb J, Georgiou A, Westbrook JI, Braithwaite J. Health professional networks as a vector for improving healthcare quality and safety: a systematic review. BMJ Qual Saf 2012;21(3):239-49 doi: 10.1136/bmjqs-2011-000187.
8. Carswell P, Manning B, Long JC, Braithwaite J. Building clinical networks: a developmental evaluation framework. 2013;Mar:1-6 doi: http://dx.doi.org/10.1136/bmjqs-2013-002405
9. Braithwaite J, Westbrook JI, Ranmuthugala G, et al. The development, design, testing, refinement, simulation and application of an evaluation framework for communities of practice and social-professional networks. BMC Health Serv Res 2009;9:162
10. Long JC, Cunningham FC, Carswell P, Braithwaite J. Patterns of collaboration in complex networks: the example of a translational research network. 2014;14(1):225 doi: 10.1186/1472-6963-14-225.
11. Long JC, Hibbert P, Braithwaite J. Structuring successful collaboration: a longitudinal social network analysis of a translational research network. 2016;11(19) doi: 10.1186/s13012-016-0381-y
12. Valente T. Network Interventions. 2012;337:49-53
13. Borgatti SP. NetDraw: graph visualization software. Harvard: Analytic Technologies, 2002.
14. Borgatti SP, Everett MG, Freeman LC. UCInet for Windows: software for social network analysis. 6 ed. Harvard: Analytic Technologies, 2002.

Resources

Complexity Science in Healthcare: A White Paper

Deeble Perspectives Brief 20. Transforming the genomics workforce to sustain high value care.

Project Sponsors

Australian Genomics Health Alliance

Related Projects

Implementation of genomic medicine into clinical practice