Understanding how professionals cultures impact implementation of a pediatric oncology genomic test

Abstract

Purpose Healthcare innovation, exemplified by genomic medicine, requires increasingly sophisticated understanding of the interdisciplinary-organizational context in which new innovations are implemented. Deliberative stakeholder consultations are public engagement tools that are gaining increasing traction in health care, as a means of maximizing the diversity of roles and interests vested in a particular policy or practice issue. They engage participants from different knowledge systems (“cultures”) in mutually respectful debate to enable group consensus on implementation strategies. Current deliberation analytic methods tend to overlook the cultural contexts of the deliberative process. The paper aims to discuss this issue. Design/methodology/approach This conceptual paper proposes adding ethnographic participant observation to provide a more comprehensive account of the process that gives rise to deliberative outputs. To underpin this conceptual paper, the authors draw on the authors’ experience engaging healthcare professionals during implementation of genomics in the care for pediatric oncology patients with treatment-resistant glioblastoma at two tertiary care hospitals. Findings Ethnography enabled a deeper understanding of deliberative outcomes by combining rhetorical and non-rhetorical analysis to identify the implementation and coordination of care barriers across professional cultures. Originality/value This paper highlights the value of ethnographic methods in enabling a more comprehensive assessment of the quality of engagement across professional cultures in implementation studies.