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Role innovation in diagnostic radiography: Impact of organisational culture

Faculty of Health Studies

About the Project

This project looks to explore the features of professional and organisational leadership and culture on skills mix adoption for radiographers and consider how we can learn from positive variants organisations, developing a framework or toolkit to enable implementation.

Diagnostic imaging is now central to the diagnosis, staging or monitoring of most, if not all, patient disease pathways. The opportunities within diagnostic imaging have expanded and continue to grow with new and advancing technologies. Last year 44.8 million imaging examinations1 were performed in England, an increase of 40% over a decade. To meet this increasing demand, the expectations of the imaging workforce have changed with radiographer role extension and advancement promoted as part of the national Imaging Skills Mix strategy launched in 2003.2  The expectation was to optimise the use of radiographer knowledge and skills to enable the delegation of ‘more routine’ tasks previously undertaken by radiologists, releasing them to undertake more ‘complex’ work although the terms routine and complex were not specifically defined or universally understood.

Despite the promotion of broadening radiographer roles and responsibilities, there has been an inconsistent approach and adoption. A small number of NHS Trusts across the UK have embraced skills mix and embedded the 4 tier structure and these are held as beacons of professional opportunity within the Radiography profession. However, other departments have not been as progressive in skills mix implementation leaving many radiographers frustrated at the limited clinical career opportunities and NHS Trust financially constrained due to the outsourcing of work to the independent sector to support activity. The reasons for the variation or often cited in the literature as being professional protectionism by radiology or rigid organisational culture. The introduction of 7-day services and early cancer diagnostics further increased this pressure of services and emphasised the need for diagnostic imaging department to explore new ways of working and adoption of new roles and responsibilities for radiographers to ensure effective change to the way services are delivered can be achieved without compromising access or quality.

Research proposals exploring skills mix implementation are welcomed and a variety of approaches are possible depending on the interest of the applicant. These may include:

Survey approaches to explore the enablers and barriers to skills mix adoption, what the roles might be and benefits/harm of role development (patient, financial, professional and personal);

A positive variance study of organisational models potentially involving ethnographic exploration;

Creation of a unified understanding of terms and roles and framework for adoption.


NHS England & NHS Improvement. Diagnostic Imaging Dataset Annual Statistical Release 2018/19. 2019.

Department of Health. Radiography Skills Mix: A Report on the Four‐Tier Service Delivery Model. HMSO, London, 2003.

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