PDF(Pubmed)
Abstract：
BACKGROUND: The United Kingdom (UK) government\'s healthcare policy in the early 1990s paved the way adoption of the skills mix development and implementation of diagnostic radiographers\' X-ray reporting service. 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 longitudinal macro, meso, and micro barriers and enablers to the implementation of the diagnostic radiographer musculoskeletal X-ray reporting service in the National Healthcare System (NHS) in England.
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) and recorded in a PRISMA flow chart. A combination of keywords, Boolean logic, truncation, parentheses and wildcards with inclusion/exclusion criteria and a time frame of 1995-2022 was applied. The literature was assessed against Joanna Briggs Institute\'s critical appraisal checklists. With meta-aggregation to synthesize each paper, and coded using NVivo, with context grouped into macro, meso, and micro-level sources and categorised into subgroups of enablers and barriers.
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.
CONCLUSIONS: The literature since 1995 has reframed the debates on implementation of the radiographer reporting role and has been instrumental in shaping clinical practice. There has been clear influence upon both meso (professional body) and macro-level (governmental/health service) policies and guidance, that have shaped change at micro-level NHS Trust organisations. There is 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. All of which have contributed to conceptual understandings of the skills mix workforce within modern radiology services.
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) and recorded in a PRISMA flow chart. A combination of keywords, Boolean logic, truncation, parentheses and wildcards with inclusion/exclusion criteria and a time frame of 1995-2022 was applied. The literature was assessed against Joanna Briggs Institute\'s critical appraisal checklists. With meta-aggregation to synthesize each paper, and coded using NVivo, with context grouped into macro, meso, and micro-level sources and categorised into subgroups of enablers and barriers.
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.
CONCLUSIONS: The literature since 1995 has reframed the debates on implementation of the radiographer reporting role and has been instrumental in shaping clinical practice. There has been clear influence upon both meso (professional body) and macro-level (governmental/health service) policies and guidance, that have shaped change at micro-level NHS Trust organisations. There is 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. All of which have contributed to conceptual understandings of the skills mix workforce within modern radiology services.
摘要：
背景：1990年代初，英国（UK）政府的医疗保健政策为采用技术混合开发和实施X射线诊断技师报告服务铺平了道路。英国公共医疗保健系统内的当前临床实践反映了与1990年代一样的患者影像学需求增加和报告劳动力（放射技师和放射科医师）能力有限的压力。本研究旨在确定，定义和评估纵向宏观，meso,以及在英格兰国家医疗保健系统（NHS）中实施放射诊断技师肌肉骨骼X射线报告服务的微障碍和推动者。
方法：搜索了多个独立数据库，包括PubMed,OvidMEDLINE；Embase；CINAHL，和谷歌学者，以及期刊数据库(Scopus，Wiley),医疗保健数据库(NHS证据数据库；Cochrane图书馆)和灰色文献数据库(OpenGrey，GreyNetInternational,和大英图书馆EthOS存放处），并记录在PRISMA流程图中。关键词的组合，布尔逻辑,截断,括号和通配符包含/排除标准,时间范围为1995-2022年.这些文献是根据乔安娜·布里格斯研究所的批判性评估清单进行评估的。通过元聚合来合成每篇论文，并使用NVivo编码，将上下文分组为宏，meso,和微观层面的来源，并分类为推动者和障碍的子组。
结果：广泛多样的数据（n=241篇论文）确定了实施的障碍和促成因素，被归类为宏观的衡量标准，meso,微观层面，和主题类别的背景，文化,环境,和领导力。
结论：自1995年以来的文献重新讨论了关于实施放射技师报告角色的争论，并在塑造临床实践中发挥了重要作用。对中观(专业机构)和宏观(政府/卫生服务)政策和指导都有明显的影响，这在微观层面的NHS信托组织中形成了变化。有证据表明，围绕技能混合接受度和角色边界，不同中观专业机构内部和之间的文化根深蒂固的传统观点发生了转变。这有助于塑造报告队伍的能力建设。所有这些都有助于对现代放射学服务中的技能组合劳动力的概念理解。
方法：搜索了多个独立数据库，包括PubMed,OvidMEDLINE；Embase；CINAHL，和谷歌学者，以及期刊数据库(Scopus，Wiley),医疗保健数据库(NHS证据数据库；Cochrane图书馆)和灰色文献数据库(OpenGrey，GreyNetInternational,和大英图书馆EthOS存放处），并记录在PRISMA流程图中。关键词的组合，布尔逻辑,截断,括号和通配符包含/排除标准,时间范围为1995-2022年.这些文献是根据乔安娜·布里格斯研究所的批判性评估清单进行评估的。通过元聚合来合成每篇论文，并使用NVivo编码，将上下文分组为宏，meso,和微观层面的来源，并分类为推动者和障碍的子组。
结果：广泛多样的数据（n=241篇论文）确定了实施的障碍和促成因素，被归类为宏观的衡量标准，meso,微观层面，和主题类别的背景，文化,环境,和领导力。
结论：自1995年以来的文献重新讨论了关于实施放射技师报告角色的争论，并在塑造临床实践中发挥了重要作用。对中观(专业机构)和宏观(政府/卫生服务)政策和指导都有明显的影响，这在微观层面的NHS信托组织中形成了变化。有证据表明，围绕技能混合接受度和角色边界，不同中观专业机构内部和之间的文化根深蒂固的传统观点发生了转变。这有助于塑造报告队伍的能力建设。所有这些都有助于对现代放射学服务中的技能组合劳动力的概念理解。
