Driving the bus: A radiology case study utilizing rich picture diagramming and CATWOE to capture staff perceptions and inform service improvement scenarios

Introduction: Demand for computed tomography (CT) services is increasing. This empirical work in a CT setting, examines how qualitative methods were used to identify staff perceptions and opportunities for service improvement. The use of soft systems methodologies (SSM) as an action research tool in radiology is considered. Methods: Hospital Staff were interviewed to create a root definition of the CT service. In a diagramming session, a rich picture (RP) was created and augmented with staff input. Utilizing the RP, a session was facilitated with radiology decision makers to identify a list of culturally desirable and feasible process improvement scenarios. Results: Root definitions were created of the CT service from the perspective of the staff. The RP graphically illustrated the key features of the CT service and represented a shared understanding of the service. A targeted set of culturally feasible and desirable service improvement recommendations were identified. Four directly attributable implemented workflow changes were identified. Conclusion: RP diagramming provided an opportunity to involve staff in research while capturing their perceptions and resulted in a shared understanding as well as targeted opportunities for CT service improvement. The implemented workflow changes resulting from the SSM approach demonstrated its use as an action research tool.