Assessing the barriers and enablers to the implementation of the diagnostic radiographer musculoskeletal X-ray reporting service within the NHS in England: A Systematic literature review

Abstract

Introduction: The United Kingdom (UK) government's healthcare policy in the early 1990s paved the way for healthcare professionals to adopt wider clinical practice roles, resulting in the skills mix development and implementation of diagnostic radiographers' X-ray reporting service in clinical practice. Current clinical practice within the public UK healthcare system reflects the same pressures of increased demand in patient imaging and limited capacity of the reporting workforce (radiographers and radiologists) as in the 1990s. This study aimed to identify, define and assess the implementation of the diagnostic radiographer X-ray reporting service in the National Healthcare System (NHS) in England, which have impacted the implementation and expansion of this advanced practice. Methods: Multiple independent databases were searched, including PubMed, Ovid MEDLINE; Embase; CINAHL, and Google Scholar, as well as journal databases (Scopus, Wiley), healthcare databases (NHS Evidence Database; Cochrane Library) and grey literature databases (OpenGrey, GreyNet International, and the British Library EthOS depository). A combination of keywords, Boolean logic, truncation, parentheses and wildcards with inclusion/exclusion criteria and a time frame of 1995-2022 was applied. The resulting literature was assessed against Joanna Briggs Institute's critical appraisal checklists. The results were displayed in a PRISMA flow chart and a thematic matrix. Results: The wide and diverse range of data (n=241 papers) identified barriers and enablers of implementation, which were categorised into measures of macro, meso, and micro levels, and thematic categories of context, culture, environment, and leadership. Conclusion: The literature since 1995 has reframed the debates on implementation of the radiographer reporting role and has been instrumental in shaping clinical practice and behaviours. There has been clear influence upon both meso (professional body organisations) and macro-level (governmental/health service) policies and guidance, that have shaped change at micro-level NHS Trust organisational levels. There is clear evidence of a shift in culturally intrenched legacy perspectives within and between different meso-level professional bodies around skills mix acceptance and role boundaries. This has helped shape capacity building of the reporting workforce and radiographer technical skills development. All of which have contributed to conceptual understandings of the skills mix workforce within modern radiology services and helped improve downstream patient diagnosis, treatment and management outcomes. Implications for practice: The findings of this study can help to inform and support implementation strategies and facilitation of the diagnostic radiographer X-ray reporting service in NHS clinical practice.