Advanced and extended scope practice of diagnostic radiographers in Scotland: Exploring strategic imaging service imperatives
Introduction
Across the United Kingdom (UK), demographic change, evolving technology and fiscal challenges have created substantial pressures on the delivery of diagnostic imaging services. Government health policy measures have sought to address those pressures.1, 2 Although Scotland has a fully devolved health and social care system, those pressures exist in essentially the same way as the rest of the UK and the policy elements manifest similar features.3, 4, 5 These include ‘modernisation’ or redesign of services, integration of health and social care, implementation of skill mix and developed roles for non-medical practitioners, and the notion of patient centredness in respect of strategic service delivery and visioning.
In 2012 the Scottish Government published its Allied Health Professions Delivery Plan (AHPDP)6 outlining the role of AHPs in transforming the Health service into a more patient centred and effective service. The plan made a clear statement of the need to have a ‘significant’ (though unspecified) proportion of plain film images reported by radiographers.
The implementation of policy is an influential means by which change occurs and there is evidence that in a UK context the Scottish experience of service evolution and change is subject to a notable lag factor.7, 8 In the context of diagnostic radiography, this is manifested by poorer implementation of skill mix, role developments and advanced practice, confirmed in earlier research.7, 9 The reasons for this are multi-factorial however notably, the devolved arrangements in Scotland are characterised by a structurally and culturally different system of management and leadership.10 Arguably this remains less ‘commercialised’ and more traditional in operation compared to the recent English experience. It may also be the case that a smaller professional community and substantial remote and rural constituency have some impact.
The operational ‘reality’ of developing extended scope and advanced practice roles for radiographers in Scotland has been explored in earlier research and some reasons for the existing service landscape identified.9, 11, 12 It is important in this context to examine the strategic and visionary aspects of service evolution in order to seek clarity in negotiating the path forward. Awareness of the perspectives of those involved in strategic management of imaging services is crucial in order to identify the facilitators and barriers to developing the service model for patient benefit.
Section snippets
Aims
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Examine the strategic factors that influence the implementation of service change.
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Identify drivers and inhibitors of change.
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Establish a perspective on how change can be achieved, looking ahead.
Method
The participants in this research were those with Health Board (Regional) level responsibility for imaging services and involvement in operational planning and development at a strategic level. They are referred to here under the generic term ‘strategic manager’. Job specific questionnaires were sent to strategic managers in each of the fourteen Health Board areas across Scotland. There were two phases: a quantitative questionnaire survey and qualitative semi-structured telephone interviews.
Data analysis
Phase 1: Quantitative analysis was primarily descriptive and presented in tabular form. Inferential analysis was inappropriate for such a low sample size.
Phase 2: The recorded interviews were transcribed and anonymised. Data analysis utilised the fivefold process recommended by Pope et al.15: 1) familiarisation; 2) identifying a thematic framework; 3) indexing; 4) charting and mapping; and 5) interpretation
Questionnaires
From fourteen administered, eight questionnaires were returned giving a 57% response rate, following three email reminders and extension of the return deadline by two weeks which provided an additional two responses. Throughout the results section, participants' comments are shown in parenthesis.
Discussion
This work is the second phase of a larger study9 and considers the strategic insights of service managers with Board level responsibility. Response rates to both questionnaire and interview invitations were disappointing. The 57% return on the questionnaire is superficially quite good, however this should be seen in the context of the overall sample (N = 14) which amounted to the entire population. Interview uptake was particularly poor (n = 3), limiting the breadth of perspectives that could
Conclusion
Strategic managers demonstrate commitment and motivation to move their services forwards in line with wider priorities. They demonstrate optimism regarding the ‘direction of travel’ of diagnostic services. There are however a variety of practical and cultural obstacles in place that create substantial difficulties in enabling progress. These include funding and employment conditions but also quite significantly, the attitudes and actions of professionals themselves.
The relationship between the
Conflict of interest statement
None.
Acknowledgements
The authors would like to acknowledge the cooperation and efforts of those who took part in the study and funding from the College of Radiographers Industry Partnership (CoRIPS) that enabled this work to take place.
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