Lockwood Paul, Burton Christopher, Shaw Theresa, Woznitza Nicholas, Compton Emma, Groombridge Heather, Hayes Natasha, Mane Uday, O'Brien Anna, Patterson Stephanie
School of Allied Health Professions, Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent, UK.
Present address: School of Allied Health Professions, Public Health and Social Work, Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Kent, UK.
BMC Health Serv Res. 2025 Feb 14;25(1):248. doi: 10.1186/s12913-025-12356-x.
The National Healthcare Service (NHS) radiology service delivery in London is representative of the current pressures and challenges faced in England of Musculoskeletal (MSK) X-ray reporting workforce shortages, and national turnaround time (TATs) targets. The implementation project evaluated facilitation as a strategy to achieve the NHS England 50% target for all MSK X-rays to be reported by radiographers.
The project was an eight-month multi-centre (n = 5 London NHS Trusts) study applying the Promoting Action on Research Implementation in Health Services (PARIHS) framework with embedded mixed-methods evaluation. Initial observational data using the Context Assessment Index (CAI) tool and the Workplace Culture Critical Analysis Tool (WCCAT) set the implementation interventions which comprised external facilitation, to support internal facilitators action learning activities. Evaluation data comprised monthly reporting performance, systems mapping, interviews.
System mapping allowed a perspective beyond the characteristics of the NHS Trusts involved (small single site hospitals to large multi-sites hospitals) of mixed clinical duties, scope of practice, reporting session allocation, and equipment used. CAI scores for workplace culture demonstrated = 73.7% (SD 6.8; 95%CI 8.49), leadership scored = 69.3% (SD 7.3; 95% CI 9.17), and evaluation scored = 75.5% (SD 6.9; 95% CI 98.63). WCCAT observations provided themes for facilitation focusing on remote reporting, insourcing backlogs, prioritising worklists to reduce breaching TATs, reporting metrics, and reducing auto reporting. The combined reporting of MSK X-rays by London radiographers during this study achieved = 53.7%.
This study had an innovative approach using an implementation facilitation framework to improve service delivery. The clinical workplace context in which MSK X-ray reporting by radiographers occurs was key to implementing change. The complexities of sustaining and upscaling MSK X-ray reporting by radiographers to meet the NHS England target of 50% are varied and require local champions to facilitate and drive change at organisational levels. It is recommended that there are dedicated 'resources' to sustain implementations with a community of practice for support. Workplace leadership and stakeholder networks are needed to sustain improved working practices and embrace regular evaluation and monitoring of service delivery performance.
伦敦国民医疗服务体系（NHS）的放射科服务代表了英格兰目前在肌肉骨骼（MSK）X线报告劳动力短缺以及全国周转时间（TAT）目标方面所面临的压力和挑战。该实施项目评估了促进策略，以实现NHS英格兰设定的目标，即所有MSK X线检查报告由放射技师完成的比例达到50%。
该项目是一项为期八个月的多中心（n = 5个伦敦NHS信托机构）研究，应用了卫生服务研究实施促进行动（PARIHS）框架，并进行了嵌入式混合方法评估。使用背景评估指数（CAI）工具和工作场所文化批判性分析工具（WCCAT）收集的初始观察数据确定了实施干预措施，其中包括外部促进，以支持内部促进者的行动学习活动。评估数据包括每月报告绩效、系统映射和访谈。
系统映射提供了一个超越所涉及的NHS信托机构（从小型单站点医院到大型多站点医院）特点的视角，涵盖了混合临床职责、实践范围、报告时段分配和使用的设备。工作场所文化的CAI得分显示为73.7%（标准差6.8；95%置信区间8.49），领导力得分为69.3%（标准差7.3；95%置信区间9.17），评估得分为75.5%（标准差6.9；95%置信区间98.63）。WCCAT观察提供了促进的主题，重点是远程报告、内部积压处理、优先排序工作清单以减少违反TAT、报告指标以及减少自动报告。在本研究期间，伦敦放射技师对MSK X线检查报告的综合完成率达到了53.7%。
本研究采用了创新方法，使用实施促进框架来改善服务提供。放射技师进行MSK X线报告的临床工作场所背景是实施变革的关键。要维持并扩大放射技师对MSK X线检查报告的完成率以达到NHS英格兰50%的目标，存在各种复杂情况，需要当地的倡导者在组织层面推动和促进变革。建议有专门的“资源”来维持实施，并通过实践社区提供支持。需要工作场所领导力和利益相关者网络来维持改进的工作实践，并定期评估和监测服务提供绩效。
