Experiences of diagnostic radiographers in the workplace and its effect on service quality : a case study in the eThekwini health district of KwaZulu-Natal

Abstract

The South African public health system (SAPHS) has been plagued by a burden of diseases and ill health. Although there are many Acts and policies in place in South Africa (SA) to maintain the constitutional rights of all citizens using public health facilities, suboptimal service quality and unfair treatment of patients in public health facilities continue to be documented. At the same time, staff employed within the SAPHS perceive themselves to be overworked, overburdened, stressed and to receive no support. The workplace environment of an employee is considered a vital component in ensuring employee motivation and satisfaction; a suitable work environment improves employee productivity and service quality. Several studies on other similar health disciplines, both local and international, have found that there is a reciprocal relationship between suboptimal service quality and the workplace environment (Mosadeghrad 2014: 85-87; Nkosi 2014: 67-70; Segnon 2014: 90-93). Radiographers constitute a fundamental component of the public health service and an understanding of how they experience their workplace environment is imperative. PURPOSE The purpose of this case study was to explore the workplace experience of diagnostic radiographers and to examine the effect/s of their experience on radiography service quality in the regional public health sector. METHOD The study was based on a qualitative, case study design that was explorative and descriptive in nature. A constructivist approach was used to construct the workplace experiences of regional diagnostic radiographers regarding their workplace environment. A purposeful sampling technique was utilised to select the radiography managers and the snowball sampling technique was utilised to select the diagnostic radiographers. In total, 24 regional diagnostic radiographers were interviewed for this study, both at management and non-managerial/operational levels. Both semi-structured interviews and focus group interviews were employed in this study. An audio recorder was used to capture the interviews and all interview transcripts were transcribed verbatim. The data was analysed using qualitative content analysis. All emergent themes were analysed and understood in relation to the study’s conceptual framework namely: (physical workplace environment, workplace rewards and incentives, managers’ support and communication) and the theoretical framework was used to guide the study findings. RESULTS The findings show that there was a reciprocal relationship between suboptimal radiography service quality and the workplace environment that participant radiographers were exposed to whilst conducting their duties. The main study findings include the following: there were limited functional units to service the large workloads that were encountered; faulty and old equipment resulting in frequent repeats which cause a radiation hazard; and using faulty equipment physically compromises staff and results in an occupational health risk and as potential iatrogenic injuries for patients too. Radiography equipment is not ergonomically friendly and results in radiographers experiencing discomfort and strain whilst conducting their duties. These experiences are compounded by staff shortages, unmanageable workloads and inadequate ventilation and space limitations. Further to this, unsatisfactory rewards and poor incentives, together with inadequate employee management performance and development systems and employee assistance programmes, demotivate diagnostic radiographers. Some managerial concerns reported by radiographers included: suboptimal implementation of standard operating procedures; suboptimal support for orientation and professional training and development; suboptimal motivation through rapport, recognition and support; poor management of workplace conflict; unapproachable managers; and no contribution in decision-making. Other areas of concern were the communication challenges experienced due to suboptimal departmental communication channels, poor communication skills of diagnostic radiographers, and language and translation. All of these workplace experiences were seen to have a negative effect on radiography service quality.DISCUSSION Maslow’s (1968) hierarchy of needs was used to provide a meaningful interpretation of the results. Diagnostic radiographers require the realisation of these workplace needs. In relation to the physiological needs, diagnostic radiographers require adequate staffing and manageable workloads. The safety needs are to work with and provide patients with a safe environment in respect to x-ray equipment, ventilation and space. Safety needs also require that diagnostic radiographers have effective communication channels within all levels of the radiography department. They also need to be able to interact effectively with clinicians and other health professionals in conveying information regarding patients. There needs to be proper communication techniques when obtaining informed consent and positioning patients during radiography examinations. Regarding social needs, diagnostic radiographers require support for proper orientation, professional training and development, adequate implementation of standard operating procedures (SOPs), adequate workplace conflict resolution, and effective and adequate support from employee assistance programmes. Diagnostic radiographers’ esteem needs appear to be addressed when they are provided with adequate compensation packages, allowances and receive recognition through well implemented employee performance management and development systems. Lastly diagnostic radiographers’ self-actualisation needs appear to be attained when they are included in decision-making and are provided with adequate managerial motivation, recognition and support. This need is also attained when diagnostic radiographers are given the ability to manifest innovation and creativity in the workplace, have a sense job autonomy and an increased sense of responsibility. CONCLUSION Diagnostic radiographers working within regional public health institutions experience various challenges relating to their workplace environment and this affects their radiography service quality. In keeping with Maslow’s (1968) theory of hierarchy of needs, this study affirms that it may be possible to achieve high performance from diagnostic radiographers, when their’ hierarchical needs are satisfied. The findings of this study may contribute toward policy changes that may address the challenges experienced by diagnostic radiographers and bring about change to improve their motivation and job satisfaction. The results may benefit the National Health Insurance scheme to better implement their strategic goals and plans and could have the potential to positively influence the radiography workplace environment and ultimately bring about change in the radiography service quality.