An implementation facilitation intervention to improve the musculoskeletal X-ray reporting by radiographers across London
Abstract Background 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 proj...
Saved in:
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-02-01
|
| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12913-025-12356-x |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850067937762738176 |
|---|---|
| author | Paul Lockwood Christopher Burton Theresa Shaw Nicholas Woznitza Emma Compton Heather Groombridge Natasha Hayes Uday Mane Anna O’Brien Stephanie Patterson |
| author_facet | Paul Lockwood Christopher Burton Theresa Shaw Nicholas Woznitza Emma Compton Heather Groombridge Natasha Hayes Uday Mane Anna O’Brien Stephanie Patterson |
| author_sort | Paul Lockwood |
| collection | DOAJ |
| description | Abstract Background 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. Methods 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. Results 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 $$\overline{x}$$ x ¯ = 73.7% (SD 6.8; 95%CI 8.49), leadership scored $$\overline{x}$$ x ¯ = 69.3% (SD 7.3; 95% CI 9.17), and evaluation scored $$\overline{x}$$ x ¯ = 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 $$\overline{x}$$ x ¯ = 53.7%. Conclusion 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. |
| format | Article |
| id | doaj-art-95cc3d93acea43a2b717c1ed66564784 |
| institution | DOAJ |
| issn | 1472-6963 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj-art-95cc3d93acea43a2b717c1ed665647842025-08-20T02:48:11ZengBMCBMC Health Services Research1472-69632025-02-0125111910.1186/s12913-025-12356-xAn implementation facilitation intervention to improve the musculoskeletal X-ray reporting by radiographers across LondonPaul Lockwood0Christopher Burton1Theresa Shaw2Nicholas Woznitza3Emma Compton4Heather Groombridge5Natasha Hayes6Uday Mane7Anna O’Brien8Stephanie Patterson9School of Allied Health Professions, Faculty of Medicine, Health and Social Care, Canterbury Christ Church UniversitySchool of Allied Health Professions, Faculty of Medicine, Health and Social Care, Canterbury Christ Church UniversitySchool of Allied Health Professions, Faculty of Medicine, Health and Social Care, Canterbury Christ Church UniversitySchool of Allied Health Professions, Faculty of Medicine, Health and Social Care, Canterbury Christ Church UniversityRadiology Department, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ HospitalRadiology Department, University College London Hospitals NHS Foundation Trust, University College HospitalRadiology Department, Homerton Healthcare NHS Foundation Trust, Homerton HospitalRadiology Department, Royal Free London NHS Foundation TrustRadiology Department, Kings College Hospital NHS Foundation Trust, King’s College HospitalRadiology Department, Kings College Hospital NHS Foundation Trust, King’s College HospitalAbstract Background 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. Methods 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. Results 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 $$\overline{x}$$ x ¯ = 73.7% (SD 6.8; 95%CI 8.49), leadership scored $$\overline{x}$$ x ¯ = 69.3% (SD 7.3; 95% CI 9.17), and evaluation scored $$\overline{x}$$ x ¯ = 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 $$\overline{x}$$ x ¯ = 53.7%. Conclusion 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.https://doi.org/10.1186/s12913-025-12356-xReporting radiographers; musculoskeletal; X-raysImplementation facilitation |
| spellingShingle | Paul Lockwood Christopher Burton Theresa Shaw Nicholas Woznitza Emma Compton Heather Groombridge Natasha Hayes Uday Mane Anna O’Brien Stephanie Patterson An implementation facilitation intervention to improve the musculoskeletal X-ray reporting by radiographers across London BMC Health Services Research Reporting radiographers; musculoskeletal; X-rays Implementation facilitation |
| title | An implementation facilitation intervention to improve the musculoskeletal X-ray reporting by radiographers across London |
| title_full | An implementation facilitation intervention to improve the musculoskeletal X-ray reporting by radiographers across London |
| title_fullStr | An implementation facilitation intervention to improve the musculoskeletal X-ray reporting by radiographers across London |
| title_full_unstemmed | An implementation facilitation intervention to improve the musculoskeletal X-ray reporting by radiographers across London |
| title_short | An implementation facilitation intervention to improve the musculoskeletal X-ray reporting by radiographers across London |
| title_sort | implementation facilitation intervention to improve the musculoskeletal x ray reporting by radiographers across london |
| topic | Reporting radiographers; musculoskeletal; X-rays Implementation facilitation |
| url | https://doi.org/10.1186/s12913-025-12356-x |
| work_keys_str_mv | AT paullockwood animplementationfacilitationinterventiontoimprovethemusculoskeletalxrayreportingbyradiographersacrosslondon AT christopherburton animplementationfacilitationinterventiontoimprovethemusculoskeletalxrayreportingbyradiographersacrosslondon AT theresashaw animplementationfacilitationinterventiontoimprovethemusculoskeletalxrayreportingbyradiographersacrosslondon AT nicholaswoznitza animplementationfacilitationinterventiontoimprovethemusculoskeletalxrayreportingbyradiographersacrosslondon AT emmacompton animplementationfacilitationinterventiontoimprovethemusculoskeletalxrayreportingbyradiographersacrosslondon AT heathergroombridge animplementationfacilitationinterventiontoimprovethemusculoskeletalxrayreportingbyradiographersacrosslondon AT natashahayes animplementationfacilitationinterventiontoimprovethemusculoskeletalxrayreportingbyradiographersacrosslondon AT udaymane animplementationfacilitationinterventiontoimprovethemusculoskeletalxrayreportingbyradiographersacrosslondon AT annaobrien animplementationfacilitationinterventiontoimprovethemusculoskeletalxrayreportingbyradiographersacrosslondon AT stephaniepatterson animplementationfacilitationinterventiontoimprovethemusculoskeletalxrayreportingbyradiographersacrosslondon AT paullockwood implementationfacilitationinterventiontoimprovethemusculoskeletalxrayreportingbyradiographersacrosslondon AT christopherburton implementationfacilitationinterventiontoimprovethemusculoskeletalxrayreportingbyradiographersacrosslondon AT theresashaw implementationfacilitationinterventiontoimprovethemusculoskeletalxrayreportingbyradiographersacrosslondon AT nicholaswoznitza implementationfacilitationinterventiontoimprovethemusculoskeletalxrayreportingbyradiographersacrosslondon AT emmacompton implementationfacilitationinterventiontoimprovethemusculoskeletalxrayreportingbyradiographersacrosslondon AT heathergroombridge implementationfacilitationinterventiontoimprovethemusculoskeletalxrayreportingbyradiographersacrosslondon AT natashahayes implementationfacilitationinterventiontoimprovethemusculoskeletalxrayreportingbyradiographersacrosslondon AT udaymane implementationfacilitationinterventiontoimprovethemusculoskeletalxrayreportingbyradiographersacrosslondon AT annaobrien implementationfacilitationinterventiontoimprovethemusculoskeletalxrayreportingbyradiographersacrosslondon AT stephaniepatterson implementationfacilitationinterventiontoimprovethemusculoskeletalxrayreportingbyradiographersacrosslondon |