1. EXECUTIVE SUMMARY
Currently there is a dire shortage of radiographers in South Africa as many seek employment overseas. South African trained radiographers are in high demand in countries such as the UK, Ireland, Canada and Australia. Radiographers in South Africa are classified by the Department of Health as a ‘scarce-skill’. Radiographers may find employment in state facilities, the private sector and may also open their own private practices.
Alongside Radiologists, Radiographers are the only other professionals who are allowed by the South African Radiation Board to own a license to operate the sophisticated and hazardous equipment used to acquire X-rays, however little interest has been shown by radiographers in South Africa to take advantage of this privilege and open their own private practices.
This study aims to explore the perceptions of radiographers about private entrepreneurship in radiology, and to recommend ‘enterprising attributes’ that radiographers should have in order to be able to open their privately owned radiology departments.
The method employed will be a qualitative phenomenology approach, using purposeful sampling method to get information rich participants. The data collection method will be in the form of participants responding to questions posed by the researcher and participating in focus group interviews.
It is anticipated that the outcome of this study will contribute to the absent literature of the perceptions of South African Radiographers on Private Practice entrepreneurship in Diagnostic Radiography and give insight to an aspect of business and entrepreneurship amongst Radiographers and other Allied Health Professions. and encourage health care professionals to take the initiative of expanding their career paths by venturing into ‘business’
There is a dire shortage of radiographers in South Africa as many seek employment overseas. The radiography profession in South Africa is classified by the Department of Health as a ‘scarce-skill’. Radiographers have employment opportunities in the public and the private sector and may also establish their own private practices (Steenkamp, 2010:01). Radiologists, through partnerships and corporations, are currently dominating well established radiology centres in the country, most of which are managed by Radiographers due to their extensive knowledge and expertise in medical imaging operations.
The Department of Health in South Africa allows radiographers the opportunity to open their own private practices and claim from medical aids, provided they are registered with the Health Professions Counsel of South Africa (HPCSA), as independent private practitioners. This is an important development, because it enables Radiographers to provide radiographic services to communities, especially in rural areas where there is little interest shown by Radiologists, perhaps due to lack of opportunities available to generate maximum profits.
Yousem and Beuchamp (2008: 326), states that, teleradiology is a consultative process by which images and patient information are transmitted to a remote location where interpretations are rendered and then returned to the requesting care provider, in this case the provider will be a radiographer who is practicing independently. This is further evidence that there is a huge possibility for radiographers to offer radiological services, which may alleviate the current state of insufficient service delivery yet at the same time create an opportunity for growth in the career path through entrepreneurship and business development in medical imaging.
In 2004 an enormous project of getting the fee and coding structures up to date in order for Radiographers to be able to practice independently and claim directly from medical aids was started by the Society of Radiographers of South Africa (SORSA). This initiative was expected to lead to an increase in Radiographer owned imaging practices (Steenkamp, 2010:01); however, the numbers of radiographic practices owned by radiographers are still very low, the transition from clinical radiographer to clinical manager in this regard is proving to be a big challenge, and it is of high importance for such a task. Studies have been conducted about radiology business practice particularly for Radiologists, but very little research has been done to evaluate the participation of radiographers or lack thereof, in private radiography practice. Only one study by Okaro and Ohagwu (2010) has been done in Nigeria to examine problems and prospects of establishing and managing radio-diagnostic centres by radiographers. In order to gain insight into this phenomenon, a qualitative study to explore radiographers’ perceptions regarding private radiography practice will have to be conducted.
1. LITERATURE REVIEW
According to Daniel, Mollura, Ezana,. Azene, Starikovskya, Thelwellc, Iosifescud, Kimblee, Polin, Garra, Stigter, Short, Johnsonj, Welchj, Walkerk, White, Javadi, Lungren, Zaheer, Goldberg, Lewin (2010: 496), access to radiology in developing countries has been widely documented, and two thirds of the world’s population lacks adequate access to medical imaging. There is no exception in South Africa especially in the rural areas, given the fact that in a population of approximately 49 million citizens, there are only 6, 105 registered qualified radiographers and ? radiologists according to the HPCSA .
Radiology and imaging can be a successful business that can earn lots of profits if managed efficiently. Despite huge investments in cash and efforts, (Okaro and Ohagwu 2010: 324) identifies several other challenges which may face private medical imaging practices such as poor infrastructure, unstable economic climate, poor business and managerial skills just to mention a few. However, Yousem and Beuchamp (2008: 22), states that these challenges can be overcome with adequate attention to technology, capital planning, business planning and finance, entrepreneurship development and operational efficiency, and the fact that failure can be minimized and growth maximized.
Given the cost, complexity, and skill requirements of radiologic services, the sustainability of radiology in developing countries has been a long-standing challenge (Daniel et.al. 2010:496). South Africa is also a developing country, the curriculum of allied health professionals particularly radiographers, has very little emphasis on business skills and entrepreneurship, therefore qualified radiographers do not possess skills and ‘enterprising attributes’ to open their private radiography departments. According to Kneale (2011: 5), enterprising attribute refers to people who are innovative, inventive, and think outside the box, people who are the best in a tough market, good at communicating ideas, enthusiastic, professional, ethical, persistent, committed, driven and multi-tasking, while Martin & Sugarman, (1996) and Chell (2007) in Farmer and Kilpatrick (2009:1652), define entrepreneurs in health sciences as individuals who make opportunity where others do not see. They describe opportunities as mental constructs, with entrepreneurs envisioning what might happen and how to realize it.
Entrepreneurship studies in Radiology, particularly in South Africa have centred mainly on the Radiology business for radiologists. There has been very little or no focus at all on radiographer’s point of view, regarding radiographic imaging business as far as literature is concerned. This necessitates the need to investigate the perceptions of radiographers’ view on this issue.
Bellalize Steenkamp (ref), has identified insufficient codes and fees that do not include equipment and practice costs as the primary barrier for radiographers who might want to open their private practices, she states that the cost structure is not representative of the examinations done, therefore it is not financially feasible for Radiographers to venture into private practice. Other concerns include issues with the Radiographer’s scope of practice; e.g. contrast administration, examinations such as Barium meals and fluoroscopy examinations. Lack of business knowledge, accounting skills, financing of practices, as well as lack of clarity from the Radiation Board regarding ownership and licensing of equipment were other factors she identified to be a major entrance barrier into private practice.
It must be emphasized that, there has been a number of radiographers who have successfully opened and operated private radiology practices in South Africa, with the aid of teleradiology which was discussed earlier in this report; however there is very little proportion compared to the number of radiographers registered with the HPCSA (Health Professions Counsel of South Africa). This study will focus on Radiographers who have not opened their practices with the aim of establishing their perceptions which will later be used to develop guidelines to help radiographers interested in private practice to do so with fewer obstacles.
1. PROBLEM STATEMENT
According to Okaro and Ohagwu (2010: 324), radiology and imaging can be a successful business that can earn lots of profits if managed efficiently. Radiographers are one of the few professionals allowed by the radiation board of South Africa to own a license to operate hazardous radiation equipment used to produce X-rays, however there has been very little interest shown by radiographers in South Africa to actively participate in establishing their private imaging practices like most radiologists in the country.
There is no study that has been done in South Africa to explore perceptions of radiographers about entrepreneurship in private practice, specifically opening and managing their own radiography practices.
1. AIMS/ PURPOSE STATEMENT
The aim of this qualitative phenomenological study is to establish and describe what perceptions prevail within the radiographers employed in the public and private sector regarding entrepreneurship in radiography as a profession.
In pursuit of the aim stated above the following three research objectives have been identified:
1. To explore and describe the perceptions of radiographers in public and private practice regarding entrepreneurship in radiography.
2. Explore the opinion of radiographers regarding the minimal role played by radiographers in private practice.
To compile a narrative report of the
PHC radiographers on their experiences,
meanings and understandings
of the need for role extension at this
1. level of care.
1. RESEARCH QUESTION
The research question that arises from the problem statement is “What are the perceptions of radiographers about entrepreneurship in radiographic imaging”.
Significance of the Study
This type of study may help us establish whether radiographers perceive the lack of their participation in private practice as a problem, or if they are satisfied as employees and not interested in this type of venture. The study may also assist in highlighting barriers that exist in this industry from a radiographer’s perspective, and also outline the role that radiographers are willing to play. Lastly the guidelines that may be developed may be useful to help willing individuals to open their private imaging centres, especially considering the fact that the current available guideline from the South African Society of Radiographers regarding private practice, is a one page checklist that does not have any guidance or details on process to follow when one considers to open their practice.
1. RESEARCH SETTING
The study will be conducted in private as well as public diagnostic radiology departments in Gauteng that have information rich Radiographers.
1. RESEARCH DESIGN
The study will use a qualitative phenomenology design; this will allow the researcher to explore the subjects’ experiences and personal opinions. It also allows in depth exploration of the phenomenon under study (Brink, 2008:113).
1. POPULATION AND SAMPLING
The population frame will constitute of all radiographers employed by the public and private radiology departments, as well as those that have their own private practices around Gauteng Hospitals, clinics, and medical centres. Purposeful sampling will be used to select information rich radiographers for focus group discussion. Purposeful sampling, another type of non probability sampling enables in depth exploration of the phenomenon under study because participants who are most knowledgeable about the phenomenon under study are chosen (Brink: 2008, 133). Participants will be interviewed until data saturation is reached on a given topic.
Inclusion criteria for participants in the focus group discussion will be
1. Radiographers who are able to speak in a group.
2. Radiographers who are willing to discuss their professional experiences and share their ideas.
3. Individuals who are open minded and have adequate experience to contribute valuable input to the proposed subject.
1. DATA COLLECTION
The central question for the focus group interviews which will be posed to the participants will be,
1. “What are your opinions about entrepreneurship in radiographic imaging, particularly private practice?
2. Would you, as a radiographer at any stage in your career consider opening your own private practice?
3. In your opinion, what are the challenges experienced by radiographers in opening their private imaging departments?”
The focus group discussions will be audio taped. In addition, field notes will be made by the researcher.
1. DATA ANALYSIS
The interviews will be audio taped and later transcribed. The transcribed data will then be read to obtain a general sense of the information; the data will then be coded. Themes will be generated from the codes and the meaning of the data will be interpreted (Creswell, 2003:191).
1. TRUSTWORTHINESS OF THE STUDY
To ensure trustworthiness of the qualitative data the principles described by Murphy and Yielder (2010: 62-67), Guba’s model will be employed, which requires, credibility, dependability, confirmability, and transferability.
To ensure reliability, the questionnaire proposed for use will be piloted at a diagnostic radiology department. The results of the pilot study will determine whether any amendments to the questionnaire will be necessary.
It will be ensured by extended engagement through conducting focus group interviews until data saturation. Peer reviewing will be done in an effort to collaborate themes. All the data that will be collected will be validated by respondents; participant will also be required to validate data that will be presented in the report. Triangulation using focused group discussions, in depth interviews and field notes, consistent with Guba’s model.
It will be ensured by extended engagement through conducting focus group interviews until data saturation. Peer reviewing will be done in an effort to collaborate themes. All the data that will be collected will be validated by respondents; participant will also be required to validate data that will be presented in the report. Triangulation using focused group discussions, in depth interviews and field notes.
Background information about the participants and the setting will be provided to allow assessment of transferability of the findings. This will also be ensured by extended engagement through conducting focus group interviews until data saturation is reached.
Written consents will be obtained from all the participants before they participate in the research study (Annexure A). The purpose of the study will be explained to every participant before commencing with the focus group interviews. Participants will be informed about the procedure to be followed during the focus group interviews and the nature of participation expected.
This research will be planned and executed in a way that will foster justice, beneficences and will exclude harm and exploitation of participants. The participants will be told that they could terminate their participation in the research study if they feel they would not like to continue without any detrimental cost. Participant will be made aware that they would not be forced to answer any question if they feel it would violate their rights and confidentiality.
Authority to conduct the research at participating departments will be obtained from the executive director of each hospital (Annexure B). Ethical approval will also be sought from the University of Johannesburg. Furthermore, the right to justice, equity and human dignity will be observed by treating every participant equally when providing an opportunity to participate.
1. POSSIBILITY OUTCOMES
It can be anticipated that the results from a study such as this may give insight to an aspect of business and entrepreneurship amongst Radiographers and other Allied Health Professions, and encourage health care professionals to take the initiative of expanding their career paths by venturing, or to an extent enquire further about private practice and entrepreneurship in their respective fields. Furthermore, this study may encourage embedding of ‘entrepreneurship’ (as described in this research paper) in the curriculum of all allied health professions, by learning institutions concerned, this is appropriate since current literature suggests that there is a deficit of entrepreneurial attributes among health workers, stating that this is a primary reason for shortage of adequate health care services globally, especially in developing countries (Daniel et.al. 2010:494).
Brink, H. (2006). Fundamentals of Reasearch Methodology for Healthcare Professionals. 2nd Edition. Cape Town: Juta & Company.
Daniel, J., Ezana, M., Starikovsky, A., Thelwellc, A., Iosifescud, S., Kimblee, C., Polin, A., Garra, B., DeStigter, K., Short, B., Johnsonj, B., Welchj, C., Walkerk, I., White, D., Javadi, S., Lungren, M., Zaheer, A., Goldberg, B., Lewin, J. (2010). White Paper Report of the RAD-AID Conference on International Radiology for Developing Countries: Identifying Challenges, Opportunities, and Strategies for Imaging Services in the Developing World. American College of Radiography. Elsivier:
Farmer, J., Kilpatrick, S. (2009). Are rural health professionals also social entrepreneurs?. Social Science & Medicine. United Kingdom: Elsevier: 1651–1658
Krefting, L. (1991). Rigor in qualitative research: The assessment of trustworthiness. The American Journal of Occupational Therapy, Vol: 45(3), 214-222.
Kneale, P. (2011). Embedding Enterprise –ways and means, skills for Leeds4Life and R-led teaching. SAAHE Conference, Potchefstroom South Africa. 30/069/2011: 1-20
Murphy, F.J. & Yielder, J. (2010) Establishing Rigour in qualitative radiography research, Radiography, Vol. 16, 62-67.
Okaro, C., Ohagwu, A. (2010). Problems and Prospects of Entrepreneurship in Medical Radiography Practice in Enugu Nigeria. European Journal of Scientific Research. Vol.41, 323-327.
Rushworth, S., Hindle, K. (2000). Global Entrepreneurship Monitor. Swinburne University of Technology. Australia. Pacific Access: 1-60
Steenkamp, B. Radiography Private Practice. http://www.radiography.ws/private-practice–healthman.html. Accessed 07/08/2011.
Yousem, D. Beauchamp, N. (2008) Radiology Business Practice. How To Succeed. Saunders (USA). Elsevier.