![Diagram][1] How are networks created and how do they evolve? Creating an optimal dynamic, leveraging skills and experiences by reaching across silos through curiosity and informal links. **Importance of informal relations and curiosity** - #### Creating and maintaining networks requires making the effort to stay aware and curious of new things happening and reaching out to people. A large part of creating these networks is also the trust and reputation you have among peers. *"We often informally email people to say, you know, to ask advice or to ask, you know, have they got a trial for a patient?"* *"In terms of establishing that network in the hospital, you are inheriting from those who were there before, but you won't get any referrals from your colleagues unless you have credibility as a clinician and as a clinical researcher or somebody who's going to take care of their patients."* **Small scale** - #### The scale of Phase 1 trials makes networks especially important to share information and identify patients. *"I think that's also why we say we've got these wider link networks, whereas if you're the huge juggernaut of a phase three, as a breast cancer doctor or a melanoma doctor, you don't need a big network (...) to get, you know, the big trials come along, and they approach the centres. But we need the smaller interacting networks to identify the rare patients for precision medicine trials, the networks to attract trials in and the networks of people to work with. And then the complexity with some of the new treatments, we need networks within the hospital, to be able to give these cellular therapies and do it safely."* **Leveraging diverse expertises: Creating Communities of Practice** - #### Networks enable cancer professionals to exchange, integrate and share data, insights, knowledge and expertise. This collaboration contributes value and learning to all involved. Importantly they provide peer support. This dynamic stimulates network-wide effects, building, embedding and spreading excellence within a community of practice. *"I think (The ECMC network) has worked effectively to allow better referral of patients and better sharing of data. And I think that's been taken up by the network as a whole. And we'll be used as an example, going forward. And so we've all got different areas of expertise, we've got different patient populations. So it's really about working together in collaboration rather than competing with each other."* **Avoiding silos / defragmentation** - #### Learning from others and sharing experiences and knowledge optimises time and is an accelerant for progress. It is important to keep a good awareness of the field, and a lack of understanding between stakeholders can be detrimental. Defragmentation and the breaking down of silos helps with organizational understanding and develops a respectful space for communication, learning and knowledge exchange. *"Because, you know, we all work in our little silos, but sometimes you don't realize until you know, by chance here that someone half a mile down the road, does something exactly the same or has done before."* *"We're all academics who work in universities. And it's a mixed bag where they really understand what we do (...) I get frustrated sometimes being at senior management meetings when they say, well, clinical trials is just doing your day job (...) And it's not that they don't understand the reputational benefits and the infrastructure required, some do, not all people do. And I think (we need) continual education of ourselves and our colleagues."* **Global Partnerships : Malawi & the threat of brain drain** - #### Global partnerships are a critical to reducing the cancer burden. Whilst social inequalities in cancer are recognised in all countries, it is most apparent in low and/or middle-income (LMIC) countries such as Malawi, where it has major effects on the social fabric and the economy. This situation highlights an essential need to train and retain a range and depth of skilled and specialised individuals locally. The loss of local-based skilled individuals to opportunities in more affluent countries is an issue. However, through investment in human capacity and retention of skills and know-how, countries develop national ownership and an ability participate in global partnerships and networks. ‘(international) partnership works based on … countries commitment to mutual respect to each other and importance of benefit to both countries’ ‘(barriers can be resolved by) training and retaining enough personnel to work in various specialties of our healthcare system. Training is important but also creating an environment that will motivate and retain these trained personnel is crucial. There should be deliberated policies that do not only plan training of personnel but also plan for availability of equipment and facilities’ [1]: https://mfr.de-1.osf.io/export?url=https://osf.io/9a8m7/?direct%26mode=render%26action=download%26public_file=False&initialWidth=560&childId=mfrIframe&parentTitle=OSF+%7C+networks.jpg&parentUrl=https://osf.io/9a8m7/&format=2400x2400.jpeg