Developing a framework of quality in radiographic service delivery in Ghana

Aim: The aim of this thesis was to develop a framework of quality in radiographic service delivery in Ghana. This aim was to fit the medico-socio-cultural context of Ghana so as to promote the radiographers with additional knowledge about quality issues in the imaging services and patient care. Methods: Mixed methods were used with a sequential explanatory design under two phases. Phase 1 was a quantitative design which employed participants’ and service perspectives. A patient satisfaction survey (questionnaire) was used to gather data from 90 adult participants who were radiographically examined and who gave voluntary consent. The service perspectives involved the basic quality assurance and quality control procedures: reject film analysis and diagnostic reference levels. Phase 2 was a qualitative design which used semi-structured interviews of six radiographers, six patients and three managers to further explore and explain the quality of service issues identified in Phase 1. Results: A reject film analysis rate of 14.55% was achieved. Diagnostic reference level values of 70 kVp and 18 mAs, and 60 kVp and 13 mAs were used to obtain images of diagnostic quality of postero-anterior (PA) chest for patients above and below average sizes. Diagnostic reference values of 75 kVp and 32 mAs, and 62 kVp and 21 mAs achieved images of diagnostic value of antero-posterior (AP) lumbar spine for patients above and below average sizes. Diagnostic values of 56 kVp and 5 mAs, and 52 kVp and 3 mAs also achieved quality images of AP knee for patients above and below average sizes. Four quality constructs were identified with diagnostic radiographic service provision both locally and nationally. The quality framework was built around the four main constructs: departmental management role, radiography workforce/staff role, quality and safety committee roles, and quality and safety outputs that would help improve efficiency and quality of radiographic service delivery in Ghana and to ensure patient satisfaction with the services delivered to them. Conclusions: The constructs contributed to service delivery theory by developing a unique quality framework that would provide policy-makers and managers a practical understanding of factors that affect quality of radiographic service delivery. Key words: Framework, quality service, reject rates, radiographic service, safety outputs.