Driving practice change for genomic care

Driving change in a complex health system is never simple. Clinicians are busy, resources are tight and new practices demand shifts in knowledge, scope and collaboration.  

Melbourne Genomics projects illustrated how building capability, shifting mindsets, simplifying processes and enabling change helped clinicians integrate genomics into everyday practice.  

Building capability 

Developing genomic capability takes time. While some clinicians take up testing quickly, many need repeated exposure and support.  

What works 

• Point-of-care resources that guide clinicians through key points in the genomic care pathway — like identifying eligible patients or ordering the right test. These worked best when they were embedded in local processes and promoted by trusted peers.  

• Timely access to genomic expertise, including embedded genetic counsellors, speciality-based genomic champions, attendance at multidisciplinary team meetings or informal support via online platforms.  

• On-the-job learning supported by embedded experts. For example, in one paediatric exome clinic, a genomics-trained paediatrician and a genetic counsellor guided clinicians through the genomic pathway with their own patients. 

Sustained capability building works best when it’s genuinely two-way. Creating space for shared learning allows genetics clinicians to gain valuable insight from understanding how different specialties deliver care, while other disciplines deepen their genomic skills through collaboration.  

There’s definitely been a two-way flow of information with me, as a [specialist], being able to provide phenotypic, diagnostic contextualisation … and then, likewise, being able to learn from the … clinical geneticists.

Clinician

Shifting mindsets 

Clinicians will only embrace new practices if they see clear benefits for their patients and their service. Some still see genomics as research-focused or the responsibility of genetics services alone. Demonstrating its clinical value — consistently and through trusted voices — is essential. 

What works 

• Show the impact: Clinicians are most persuaded by colleagues who share positive experiences and patient’s stories.  

• Start with simpler, high-yield tests that offer clear, meaningful benefits and build confidence.  

• Align with culture and speciality priorities by engaging clinical leaders early. 

• Broaden the lens: Emphasise the value beyond immediate care — such as reproductive planning and family risk information, which can be referred to genetics to manage. 

Simplifying processes 

Interventions are most effective when they’re clearly supported and integrated into daily practice. The bottom line is that if it’s unnecessarily complicated, it won’t stick. Engage users early, design for their context, and keep checking — does this work for them? 

What works  

I've printed out the traffic light sheet and stuck it on the wall of every consulting room in my hospital … to encourage my colleagues to think which patients could benefit from … genetic testing.

Clinician

• Integrate with existing processes. Improved integration of genomics isn’t always about doing more. Use insights from people on the ground to understand the current ways of working, then design processes that fit within them and refine as you go. 

• Make each step as straightforward as possible. For example, reports should be clear, actionable and easy to find. 

• Have strong support systems. Ensure staff know exactly who to ask when something isn’t clear. 

Enabling change  

Change doesn't happen just because the right structures or funding are in place — it must be actively shepherded and sustained. 

What works 

• Establish sponsorship from senior clinicians and department heads to normalise genomic practice. 

• Leverage existing expertise with a short-to-medium investment to help embed new practices.  

• Use peer influence: Support clinicians who can act as champions by modelling how to incorporate genomics into their practice.  

• Plan for sustainability by integrating change agents at all levels — not just leadership — and build succession pathways for them.  

• Understand the landscape for geneticists and specialists. Audits and relationship building can unlock knowledge and care pathways and sometimes reduce unnecessary tests or scope. 

• Raise awareness through direct engagement, such as answering questions at departmental meetings. This is more effective in driving uptake than broadcast communication, such as newsletters. 

Read more about the strategies deployed by clinical projects to drive change.