Since the emergence of digital imaging, there have been questions about the necessity of continuing reject analysis programs in imaging departments to evaluate performance and quality. As a marketing strategy, most suppliers of digital technology focus on the supremacy of the technology and its ability to reduce the number of repeats, resulting in less radiation doses given to patients and increased productivity in the department. On the other hand, quality assurance radiographers and radiologists believe that repeats are mainly related to positioning skills, and repeat analysis is the main tool to plan training needs to up-skill radiographers. A comparative study between conventional and digital imaging was undertaken to compare outcomes and evaluate the need for reject analysis. However, digital technology still being at its early development stages, setting a credible reject analysis program became the major task of the study. It took the department, with the help of the suppliers of the computed radiography reader and the picture archiving and communication system, over 2 years of software enhancement to build a reliable digital repeat analysis system. The results were supportive of both philosophies; the number of repeats as a result of exposure factors was reduced dramatically; however, the percentage of repeats as a result of positioning skills was slightly on the increase for the simple reason that some rejects in the conventional system qualifying for both exposure and positioning errors were classified as exposure error. The ability of digitally adjusting dark or light images reclassified some of those images as positioning errors.

Using POSH, this paper examines what consumers and practitioners value about health services; it also illustrates how brilliance can be theorized into health service management research and practice.

Objective To assess the effect of a total quality management (TOM) approach on the appropriateness of clinical laboratory testing of patients with acute myocardial infarction. Design Retrospective, control‐group, quasi‐experimental study. Setting Two metropolitan teaching hospitals: one involved in the intervention (TOM experimental group); the other had no intervention (control group). Intervention A multidisciplinary team involved in the development of improvement strategies, including laboratory testing guidelines, education programs, data collection, monitoring and feedback. Outcome measures Total number of requested clinically indicated and non‐clinically indicated tests. Results The proportion of clinically indicated tests that were requested increased from 77.5% to 88.2% (P<0.01) and the number of non‐clinically indicated tests was reduced by 81.7% with the introduction of the TOM strategies (P<0.01). Conclusions The introduction of a TOM approach has improved the appropriateness of test ordering in acute myocardial infarction. The reduction in non‐clinically indicated tests could produce substantial savings in hospital pathology costs, and the increase in clinically indicated tests provides better patient care.

A study was undertaken to identify the causes of unnecessary repeated medical imaging examinations. The repeat analysis study investigated repeated medical imaging examinations at two medium sized hospitals in Sydney, Australia. The analytical part of the study was conducted jointly by a radiologist and a radiographer. Overall there were 9.3% and 7.2% of total films repeated respectively at the two hospital sites. Unnecessary repeats were found to have been caused by numerous factors including: poor technical judgement, the adoption of unconventional techniques, non availability of radiologist for advice, patient movement or motion, equipment mishandling, disorganised practice and poor supervision of students. At both of the sites, senior radiographers were associated with 70.2% and 84.5% respectively of dark and light film errors, and 59.7% and 85.5% respectively of the repeated cases had students' involvement. On the other hand, junior radiographers were involved with 70.3% and 86.1 % respectively of positioning errors. It was recommended that major changes be introduced to radiographer practice including, quality control, radiological techniques, training, supervision and continuing professional development. It was also recommended that the radiologist takes a more active role in future guidance and training of radiographers.

Health reform has been a constant feature of most health systems for a number of decades and has often focused on structural change. The lexicon of health reform and health management has also become intertwined with managers reporting that reform has become a constant and that rather than influencing that change they are in fact influenced by it and by its impact on their role, professional development and career. There is a challenge for health service managers to return to a leadership role in enabling health reform. In doing so will this challenge us to think differently about management? This article addresses the significant body of research into health reform and health management through the lens of language used in reporting the context and the significant impact that it has had on the management role. It describes what directions that role might take, the qualities required in selecting capable managers and questions the current status quo in the education, training and development of this significant sector of the health system workforce. It concludes by proposing a way forward that acknowledges that contemporary health reform is shifting the paradigm of healthcare delivery in a way that requires the dominant view of health management to be challenged. This might be achieved by the use of a critical lens on the language of management, a focus on a grounded approach about what managers need to do and an acceptance of variability in that role in adaptive complex contexts. Abbreviations: DNOP – Distributed Networks of Practice; MDG – Millennium Development Goals; PHC – Primary Healthcare; PHN – Primary Health Network; SDG – Sustainable Development Goals; SEDOH – Social Economic Determinants of Health; SHAPE – Society for Health Administration Programs in Education.