BreastScreen NSW Radiographer Workforce Strategy · 4 BreastScreen NSW Radiographer Workforce Strategy Executive summary This Radiographer Workforce Strategy was commissioned to develop

BreastScreen NSW Radiographer Workforce Strategy

2 BreastScreen NSW Radiographer Workforce Strategy

Acknowledgements

BreastScreen NSW would like to thank the University of Newcastle NSW for their assistance with the Radiographer Workforce Strategy, specifically the survey we conducted with the final year Radiography students. Granting us access to these radiography students was much appreciated, as it allowed BreastScreen NSW to get an understanding of how current radiographer students viewed mammography as a specialty, and BreastScreen NSW as a possible employer.

BreastScreen NSW would also like to acknowledge the Screening and Assessment Services for their assistance with data and information about their radiographer workforce. This information has been instrumental in developing this Radiographer Workforce Strategy.

About the Cancer Institute NSW

The Cancer Institute NSW is Australia’s first statewide government cancer control agency, established under the Cancer Institute (NSW) Act 2003 to lessen the impact of cancer. Cancer touches the lives of everyone in our community. The Institute’s vision is to end cancers as we know them, by keeping as many people off the cancer journey as possible, and by improving health outcomes for those affected by cancer across the State.

The Cancer Institute NSW works across the full spectrum of cancer control; from cancer prevention and early detection, through to cancer treatment, services and care. The Institute provides grants that foster innovation in, and translation of, cancer research and build globally-relevant research capacity, as well as maintaining quality cancer data repositories and information to inform future policy, health planning and system improvements.

The Cancer Institute NSW works to achieve the objectives of the NSW Cancer Plan 2011–15 by coordinating priorities, resources and efforts among all individuals, organisations and governments involved in cancer control in NSW.

BreastScreen NSW Radiographer Workforce Strategy

State Health Publication Number (CI) 140001ISBN 978-1-74187-948-3

ContaCt details

AddressCancer Institute NSW, Australian Technology Park, Level 9, 8 Central Avenue, Eveleigh, NSW 2015

PO Box 41 Alexandria, NSW 1435

Telephone(02) 8374 5600

Websitewww.cancerinstitute.org.au www.bsnsw.org.au

[email protected] Emails sent to this address are forwarded to the appropriate person for action.

Copyright

© Cancer Institute NSW October 2013.

This work is copyright. It may be reproduced in whole or part for study or training purposes, subject to the inclusion of acknowledgement of the source. It may not be reproduced for commercial usage or sale. Reproduction for purposes other than those indicated above requires written permission from the Cancer Institute NSW.

www.cancerinstitute.org.au 3

executive summary 4

1 introduction 6

1.1 What is workforce planning? 6

1.2 The BreastScreen Program 6

1.3 Background 7

1.4 Scope 8

1.5 Objectives 9

2 trends, influences and considerations 10

2.1 Population and demographics 10

2.2 Cancer trends 13

2.3 Health workforce 14

3 Breastscreen nsW current workforce profile 15

3.1 Workforce data 15

3.1.1 Radiographers 15

3.1.2 Other disciplines and functions 18

3.2 Radiographer survey 19

3.2 University student survey 22

4 interviews 24

4.1 Strengths 25

4.2 Weaknesses 26

4.3 Opportunities 27

4.4 Threats 28

5 emerging themes and recommendations 29

5.1 Increasing population within the target age range 29

5.2 Generational workforce 30

5.3 Model of care 32

5.4 Mammography as a speciality 34

5.5 Optimal processes 35

5.6 Training and development 36

6 action plan 37

6.1 Increasing population within the target age range 37

6.2 Generational workforce 38

6.3 Model of care 38

6.4 Mammography as a speciality 39

6.5 Optimal processes 39

6.6 Training and development 40

appendix 1: radiographer survey 41

appendix 2: University survey 43

references 44

Contents


Executive summary

This Radiographer Workforce Strategy was commissioned to develop a clear understanding of BreastScreen NSW’s Radiographer workforce. It explores the profile of the current radiographer workforce and the future requirements for this group of employees. This strategy also investigates anecdotal concerns relating to an ageing radiographer workforce, perceived supply shortages of radiographers, increasing population in the target age group and continuing pressures to increase participation rates.

The scope of this Workforce Strategy was restricted to the BreastScreen NSW radiographer workforce and did not consider other clinical or non-clinical roles within BreastScreen NSW.

The Radiographer Workforce Strategy was developed using information collected from a variety of sources, including:

• Data collection from BreastScreen NSW’s eight Screening and Assessment Services (SAS’s)

• Surveying the current BreastScreen NSW radiographer workforce

• Surveying university students currently studying Radiography

• Interviewing SAS Directors and senior members of the BreastScreen NSW Coordination Unit

Emerging Themes

The information collected identified a number of emerging themes relating to the BreastScreen NSW radiographer workforce.

• The increasing population in NSW means that more women are going to require screening services in the future. This will have implications on the BreastScreen NSW radiographer workforce and its processes. The workforce and processes will need to have the capacity and efficiency to provide quality services to this growing population.

• The average age of BreastScreen NSW radiographers is 50. The perceived risk of a large portion of the current radiographers exiting this service is not as great a previously thought; however the need to identify strategies to manage and engage an experienced, older workforce is still a priority.

• Radiographers early in their careers are less likely to specialise in mammography, instead seeking positions that broaden their skills and scope of practice. There are opportunities to form relationships with young radiographers and identify ways for them to explore mammography with the goal of attracting them to BreastScreen NSW.

• To achieve participation rates and Program goals, while providing quality service BreastScreen NSW must consider how to have the right people in the right place at the right time. This means having the right roles (radiographers and others) at the right sites (fixed and/or mobile, rural and metro) at times that best meet the needs of NSW women.


• Mammography is a valuable radiographer specialty, and the BreastScreen NSW Program requires access to radiographers who are able to perform quality mammograms. Specialising in mammography and working for BreastScreen NSW need to be promoted as an attractive career option with a rewarding career pathway.

• Improvements to training and development have emerged as an area for improvement. It is important that radiographers are able to plan the training and education available to them, as well as having opportunities to not only improve skills in imaging, but in other areas of interest too.

• Standardisation of processes across the eight SAS’s could lead to optimised and efficient processes. Process reviews need to look at the whole client journey (not just a small part of it) and should encourage a healthy and active workplace.

Recommendations

In order to address the above findings a number of recommendations and actions have been identified. The key recommendations are:

• Understand the throughput required to achieve desired screening numbers and participation rates and determine what workforce model best enables the achievement of this.

• Develop and strengthen existing strategies to retain experienced radiographers and to attract younger radiographers

• Design a model of care for BreastScreen NSW that considers, amongst other factors, what radiographer roles look like in the future, how partnerships with other providers could be used to source radiographers and what are the optimal hours of service

• Identify and develop relationships between BreastScreen NSW and universities with radiography programs

• Standardise processes across SAS’s, ensuring efficiency and reducing waste

• Develop a training and development framework that includes career pathways for mammographers

Conclusion

Undertaking this Radiographer Workforce Strategy has enabled BreastScreen NSW to reflect on the strengths and weaknesses of its current radiographer workforce. It has also identified future opportunities and challenges that will impact this workforce over coming years. It is the role now of the BreastScreen NSW Coordination Unit and each SAS to consider the proposed recommendations and actions, and develop an implementation plan to develop these further.

The radiographer workforce is instrumental in BreastScreen NSW providing quality screening and assessment services. This Radiographer Workforce Strategy provides recommendations regarding the radiographer workforce that will assist BreastScreen NSW to maximise participation rates, provide quality screening and assessment services and meet the needs of NSW women.


1. Introduction

1.1 What is workforce planning?

Workforce planning is a process whereby organisations consider their future human resource requirements to achieve their strategic goals1. Creating a workforce strategy enables an organisation to reflect on the strengths and weaknesses of its current workforce, and to look at what opportunities and future challenges may arise that could impact that workforce.

Workforce planning provides the basis for ensuring that the right numbers of the right people are in the right place at the right time2.

In the context of BreastScreen NSW, undertaking this workforce initiative will enable BreastScreen NSW to consider future radiographer workforce models that are required to meet the future requirements of the program. This will enable NSW women in the target age group to access screening and assessment services as required, and will assist to maximise participation rates within these target age groups.

1.2 The BreastScreen program

The National Program for Early Detection of Breast Cancer was established in 1991. This program has since been renamed BreastScreen Australia, and is jointly funded by the Commonwealth and all states and territories.

BreastScreen Australia is a population-based screening program that provides free breast screening services for women aged 40 years and over.

BreastScreen Australia operates fixed and mobile screening units in more than 500 locations nationwide. Screening has increased significantly since 1991.

Women aged 50–74 are actively recruited to join the BreastScreen NSW program via an invitation when they turn 50, and with a reminder letter every two years. The program is specifically targeted at well women without symptoms.

Earlier this year the Commonwealth Government announced an increase in the target age group for BreastScreen Australia to include women aged 70–74 (previously 50–69). This change came into effect on 1July 2013 and was a key commitment to a recommendation made as part of the BreastScreen Australia Evaluation Report 2009.3

The increase in the target age group has implications for BreastScreen NSW, which include ensuring its current workforce and processes can accommodate a larger target population, and have the ability to meet target participation rates. BreastScreen NSW currently achieves a participation rate of 51.7 per cent (as at July 2013) in the previous target age group of 50–69 years and 17.5 per cent (as at July 2012) of the new age group of 70–74. The current national target for the Program for women aged 50–69 years is 70 per cent and the new target introduced for the 70–74 year age group is 55 per cent by 2017.

BreastScreen NSW is part of the national BreastScreen Australia Program. The BreastScreen NSW Coordination Unit oversees the program and is managed by the Cancer Institute NSW. Eight Screening and Assessment Services (SASs) are responsible for the delivery of the service across the State.


1.3 Background

Workforce planning is key to setting future strategies to address the challenges that the Australian health workforce may face.

In 2013 Health Workforce Australia developed a National Cancer Workforce Strategic Framework (NCWSF)4 that offers a course of action to address workforce issues for the cancer control sector. The purpose of the NCWSF is to provide a set of strategic options for adoption at national, jurisdictional and cancer organisation level; to add value to what is already underway; and to facilitate shifts to a more effective way of working.

Health Workforce Australia identified the following challenges facing the Australian health workforce: an ageing population; increased demand for health services; ageing workforce; and increasing expectations for service delivery. The cancer workforce is not immune to these challenges. The continuing growth in the number of newly-diagnosed cancer patients – combined with an increasing number of long-term cancer survivors (many with additional chronic health problems) – is likely to overwhelm Australia’s available cancer workforce.

BreastScreen NSW is conscious of these challenges and is proactively developing strategies to ensure a strong workforce in the future. When this work was commissioned, anecdotal feedback suggested that there were concerns at BreastScreen NSW about:

• a supply shortage of radiographers

• an ageing radiographer workforce

• an increase in the population in the target age group

• continued pressure on the radiographer workforce to achieve increasing participation rates and provide quality services to clients.

A desire to understand and, where appropriate, alleviate these concerns has led to the creation of this Radiographer Workforce Strategy. Its purpose is to develop a clear understanding of BreastScreen NSW’s current radiographer workforce and requirements for the future. This will allow BreastScreen NSW to consider:

• implications of the current radiographer workforce• factors that will impact the radiographer workforce in the future• strategies required to ensure that the radiographer workforce can

meet its goals and objectives• future challenges the program needs to be prepared for.


1.4 Scope

The primary focus of this workforce strategy is the BreastScreen NSW radiographers working for all Screening and Assessment Services (SASs).

Radiographers are only one part of a wider multi-disciplinary team at BreastScreen NSW. While this strategy gave consideration to the types of roles that support, impact and work alongside the radiographers; no analysis of workforce issues and strategies was done for these roles. Therefore, the following roles were out of scope:

• Radiologist

• Medical physicist

• Counsellor

• Surgeon

• Data Manager

• Administration roles

• Nurse

• Social worker

• Medical officer

• Pathologists

• Marketing and recruitment roles


1.5 Objectives

The main objective of creating a workforce strategy is to develop a clear understanding of BreastScreen NSW’s current workforce and its requirements for the future.

This workforce strategy supports a key commitment of the NSW Cancer Plan 2011-15 (the Plan). Goals 1 and 2 in the Plan relate to reducing the incidence of cancer and improving the survival of people with cancer. The objective is to ‘increase overall participation rates in breast programs in line with national programs’.5

Specific objectives of the workforce strategy are to:

• capture current radiographer workforce profiles, data and information to inform planning;

• understand future population demographics and cancer trends;

• identify current and future radiographer workforce needs, including challenges, pressures and risks;

• create short-and long-term recruitment and retention strategies for radiographers;

• identify strategies to grow the existing radiographer workforce in terms of numbers, development opportunities and models of care to meet organisation needs;

• establish new ways of working to meet the changing needs of the environment in which the radiographer workforce operates; provide training/education in identified models of quality and business improvement and efficient work practice;

• identify opportunities and provide recommendations for future workforce strategies that may relate to the wider BreastScreen multidisciplinary team;

• develop an implementation plan for these recommendations.


2.1 Population and demographics

NSW is the most populous state in Australia. In the 10 years from June 2001 to June 2011, the estimated resident population of NSW increased by 10 per cent. In 2011, 64 per cent of the total NSW population resided in Greater Sydney.6

The female population for 20137 is projected as follows:

• Projected total female population of NSW: 3,715,187

• Projected population of females eligible for the BreastScreen program (age 40 and over): 1,790,365

• Projected population of females eligible who BreastScreen NSW will specifically target (aged 50–74): 989,808

The population of eligible targeted females (aged 50–74) is projected to increase by:

• 8.6% in the next five years

• 14.9% in the next 10 years

• 23% in the next 20 years, resulting in a projected population in 2033 of 1,217,757.

Diagram 1: Projected eligible target age group population growth

There are currently eight SASs that deliver the screening and assessment services for BreastScreen NSW. These SASs are aligned with Local Health District (LHD) boundaries and are responsible for healthcare delivery in their region under the NSW Ministry of Health.

Each SAS differs in terms of geographical size, population demographics and its rural/urban split. Diagram 2 illustrates the projected population in 2013 for each SAS, compared with the actual screening performed by SAS for the year ending 30 June 2013.

2. Trends, influences and considerations


Diagram 2: SAS population and screening comparison

Diagrams 3, 4 and 5 show the impact of the projected population growth on the target age group on each SAS.

Diagram 3: Projected population of women aged 50–74, 2013

Greater Western

Greater Southern

Hunter New England

North Coast

Sydney West

Sydney South West

South East Sydney Illawarra

Northern Sydney Central CoastLegend

SAS

ProjPop_50-74years_2013

0 - 48000

48001 - 90000

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Projected Population for Women Aged 50-74 Years

0 90 18045 Kilometers

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Hunter New England

North Coast

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SAS


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Greater Western

Greater Southern

Hunter New England

North Coast

Sydney West

Sydney South West



SAS


0 - 48000

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90001 - 115000

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Greater Western

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Hunter New England

North Coast

Sydney West

Sydney South West



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Greater Western

Greater Southern

Hunter New England

North Coast

Sydney West

Sydney South West



SAS

ProjPop_ETAG_2033

0 - 48000

48001 - 90000

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Greater Western

Greater Southern

Hunter New England

North Coast

Sydney West

Sydney South West



SAS

ProjPop_ETAG_2033

0 - 48000

48001 - 90000

90001 - 115000

115001 - 135000

135001 - 165000

165001 - 185000

185001 - 195000

195001 - 255000




2.2 Cancer trends

It is well-known that breast cancer is the most commonly-diagnosed cancer in women in Australia. The number of people diagnosed with breast cancer is steadily rising; however, the mortality rate is slowly declining. This can be linked to early detection and best practice treatment of cancer, as illustrated below.

Diagram 6: Top 5 cancers in NSW females, 1972–2008 8

Diagram 7: Female mortality from breast cancer in NSW, 1972–20089


2.3 Health workforce

It has been suggested that, as the general health workforce ages, the proportion of women in the health workforce increases. As these health professionals seek to balance work and family life, they are less willing to work extended hours. Work, social and educational aspirations of health professionals and their families influence decisions about where to live and practise, and their aspirations may not easily be met outside metropolitan areas. Shortages are more significant in rural and remote regions10.

In regards to the radiography workforce, BreastScreen NSW has been concerned that:

• there may be a shortage of radiographers in the future, particularly those specialising in mammography;

• it appears difficult to attract new radiographers to BreastScreen NSW, especially those early in their careers;

• it is increasingly challenging to recruit radiographers to rural settings and keep them engaged while they are there.

These factors have future implications for the BreastScreeen NSW program. Discussions with the NSW Ministry of Health11 have highlighted a possible over-production of radiographers, and the Ministry believes the turnover of existing radiographers has slowed down. Approximately 350 radiographers graduated in NSW in 2012, and approximately 20 per cent do not have a National Professional Development Program (NPDP).

The NPDP provides a mechanism for Australian medical imaging graduates to attain recognition as an Accredited Practitioner by the Australian Institute of Radiography12. This combined with a slowing turnover of radiographers does not support the view that there is a shortage of radiographers. It implies there are radiographers graduating that could be open to opportunities with BreastScreen NSW if it could assist them achieve a NPDP placement.


3. BreastScreen NSW current workforce profile

In order to assess and understand the current BreastScreen NSW workforce, information was collected in three ways.

1. All SASs were asked to provide demographic data about their radiographers and the roles that support and/or work with these radiographers.

2. All radiographers working for BreastScreen NSW were invited to participate in a survey. The purpose of this survey was to understand how these staff view their roles, how they view BreastScreen NSW, and what they might need in the future that would encourage them to stay and/or to make them more satisfied with working for BreastScreen NSW.

3. Final year radiography students at the University of Newcastle were invited to complete a brief survey about their knowledge of, and interest in, BreastScreen NSW.

3.1 Workforce data

3.1.1 radiographersApproximately 25 per cent of BreastScreen NSW’s workforce is radiographers. Radiographers who work for BreastScreen NSW are the health professionals who take the mammograms of each woman participating in the screening program. They are experienced and qualified health professionals who need to have the following qualifications:

• A diagnostic accreditation issued by the Australian Institute of Radiography.

• Registration with Australian Health Practioner Regulation Agency (AHPRA) and relevant radiation registration or licensing. (A NSW EPA Radiation Licence is required in NSW).

Radiographers who work for BreastScreen NSW are eligible to hold a current Certificate of Clinical Proficiency in Mammography (CCPM) or be undertaking Australian Institute of Radiography accredited training, ideally within 12 months of commencing employment.

BreastScreen NSW’s radiographer workforce is managed within (and by) each SAS. The majority of the radiographer workforce is screening radiographers and due to the nature of the work involving an all-female client base, all screening radiographers are currently female. Each SAS has a chief/designated radiographer and in some SASs they are supported by an assistant chief and/or tutor radiographers.


The following summarises what each of these radiographers roles are responsible for:

Table 1: Radiographer role responsibilities

Radiographer role Responsibilities

Screening radiographer • Provide screening mammograms.

• Perform quality assurance on all equipment.

• Attend an assessment clinic at least twice per year.

Chief/designated radiographer

• Orientation and supervision of training of radiographers new to the program.

• Quality assurance, including undertaking quarterly formal reviews of mammographic quality and equipment performance.

• Liaison with the medical physicist (or equivalent), and other multidisciplinary team members.

• Attending NSW radiographer meetings.

• Ensuring a continuing education program for the radiographers.

• Keep up to date on latest developments in breast imaging.

Assistant chief radiographer

• As per the screening radiographer.

• Plus help oversee the QA program and assist the chief designated radiographer.

Tutor radiographer • Train staff in the clinical component of the CCPM.

• Have a qualification in assessment and training.

• Accredited through the CCPM accreditation body.

• Assist in training new staff.


In terms of headcount there are 110 screening radiographers employed at BreastScreen NSW. However, due to a large part-time work force, this equates to 72.6 full time equivalents (FTEs). Diagram 8 shows how these roles are spread across the eight SASs.

Diagram 8: Radiographer headcount and FTE by SAS

Radiographers have a strong clinical focus and responsibility. Diagram 9 illustrates that screening radiographers spend 93 per cent of their time on clinical duties. This is supported by the other radiographer roles that generally spend more than 50 per cent of their time on clinical duties.

Diagram 9: Radiographer clinical and non-clinical time

The age of the BreastScreen NSW radiographers ranges from 27 to 71 years, and the mean and median age is 50 years (compared to an average age of the Allied Health workforce in NSW of 40).13 61 per cent of the workforce is older than 45, and 33 per cent is older than 55.

Diagram 10: Age of radiographers

* Age data was not provided by Sydney South West SAS, and where a headcount was a locum/casual or a vacancy, age data was not provided.

0

10

20

30

40

25-34 35-44 45-54 55-64 65+ No dataprovided*

Head

coun

t

Age

Age of Radiographers


The radiographer workforce have their salaries and duties determined by their level and grade as defined in the Health Employees’ Medical Radiation Scientists (State) Award.14 The majority of radiographers are Level 3, Grade 1. At this level, they have at least two years’ experience post accreditation or registration and have developed competency in at least one sub speciality. The average salary for this level is approximately $87,000. This is a State award and is applied consistently throughout the SASs.

The total workforce budget (including Visiting Medical Officer payments) for the eight Screening and Assessment Services in NSW is approximately $28.5 million. Of this, approximately $9.1 million is for radiographers.

In addition, some SASs in NSW use private screening providers. The annual cost of private screening providers in NSW is approximately $1.5 million, a proportion of which indirectly covers radiographer costs.

Workforce costs make up approximately 75 per cent of total SAS costs.

In addition, radiographers at this level are expected to demonstrate a level of participation in teaching programs; an ability to supervise, be responsible for and assess clinical experience of undergraduate students; contribute to quality assurance activities; and display judgement, initiative and independence in problem-solving.15

3.1.2 other disciplines and functions While a core component of the BreastScreen NSW workforce is the radiographers, the program also employs a number of other clinical and non-clinical roles to provide a safe, customer-focused service.

The focus of BreastScreen NSW is clinical in nature; however, Table 2 highlights the large number of non-clinical roles employed in the SASs, particularly with an administration focus. This has implications when considering standardising processes and looking at process improvement opportunities. Many of these non-clinical processes will support and contribute to the overall efficiencies of BreastScreen NSW services.

Table 2: Clinical and non-clinical roles

Nature of role Role type Head count # Head count %

Clinical - radiographers All 126 25

Clinical - other Clinical director/coordinator 6 1Breast physician/surgeon 39 8Radiologist 79 16Counsellor 12 2Nurse 17 3Sonographer 8 2

Non-clinical Director 8 2Operations/business manager 14 3Marketing and recruitment 16 3Data management 14 3Administration 148 30Other 11 2

TOTAL 498 100


Fewer screening numbers, I used to love BreastScreen when I had time to talk to patients instead of rushing them through radiographer survey respondent

I work with a wonderful group of dedicated people. I like the women who come for their screens radiographer survey respondent

3.2 Radiographer survey

In order to understand the views of radiographers currently working for BreastScreen NSW, all of these were invited to participate in a survey (Appendix 1). The survey explored how the radiographers viewed BreastScreen NSW; the attraction of working there; and their interest in further qualifications, education and research opportunities. It provides some insight into possible influencers on retention.

Sixty per cent (71 radiographers) responded to the survey. Of the respondents, 62 per cent were satisfied or very satisfied with working for BreastScreen NSW. 13 per cent were unsatisfied or very unsatisfied.

Diagram 11: Radiographer satisfaction with working for BreastScreen NSW

The respondents that were neutral, unsatisfied or very unsatisfied were asked what would need to change to improve their satisfaction. Common responses were around there being too much pressure on numbers, the desire for improved training and ongoing education of mammographers, and the repetitive nature of the work.

Respondents were asked what the positives of working with BreastScreen NSW were by ranking eight factors. Flexible work hours ranked as the most positive factor of working with BreastScreen NSW. No on-call hours and specialising in mammography were also positive aspects. BreastScreen NSW’s reputation and the National Accreditation Standards (NAS) were the least positive factors.


Diagram 12: Positives of working for BreastScreen NSW

The most positive aspects of working for BreastScreen NSW were also the main reasons people were attracted to BreastScreen NSW initially, and why those who have worked for the program for more than five years have stayed. The length of service with BreastScreen NSW was not captured; however, of the 71 respondents, 56 of them answered the question, “If you have worked with BreastScreen NSW for more than five years, why have you stayed?” This indicates that a large proportion of the workforce has been employed by the SASs for more than five years.

Respondents were also asked about the negatives of working with BreastScreen NSW. The repetitive nature of the work, limited scope of practice, and occupational health and safety issues were ranked as the most negative aspects.

Maybe we need creative solutions to ‘mix up’ tasks during the working day radiographer survey respondent


More variety in working day to help with repetitive work related injuries, screening and assessment on combined days to lessen repetitive nature of screening radiographer survey respondent

There seems to be a huge opportunity for research that is under-utilised at present radiographer survey respondent

Diagram 13: Negatives of working for BreastScreen NSW

The survey asked radiographers about their highest qualification level. Most respondents (51%) have a diploma in radiography, 34 per cent had a radiography degree and six per cent had a Masters or PhD.

Respondents were evenly split on whether they were interested in obtaining further qualifications. A Master’s degree and being trained in ultrasound were the most common areas of interest for further qualifications. Seventy-one per cent radiographers were interested in further educational opportunities, including attending conferences/seminars, keeping up to date with new technologies and courses to improve in mammography. Forty per cent of radiographers would be interested in pursuing research opportunities.

Diagram 14: Radiographer interest in pursuing further development


More than 80 per cent of radiographers believe their specialised knowledge in mammography should be valued. They report feeling satisfied by providing a much-needed service to women, and it is important to them to provide excellent customer service so that women return for future screens.

The survey also provided respondents with an opportunity to comment on initiatives and suggestions that they believed were requirements for the future. One concern that these comments highlighted was the requirement for increased screening numbers per day, and the challenges of working in a physically and mentally repetitive environment. There is a concern among radiographers that these issues may lead to injuries, and occupational health and safety concerns.

There were suggestions that more flexibility across modalities, and more variety in their role could improve the satisfaction of the radiographer workforce.

Some respondents wanted more training opportunities and greater involvement in planning and decision-making. A more consultative and informative environment was sought.

3.2 University Student Survey

While the main focus for the staff survey was to seek feedback from the current BreastScreen NSW workforce, it was decided it would be relevant to seek the views of those currently studying radiography and how they see BreastScreen NSW as a potential future employer. The responses obtained provide some insight into possible recruitment influencers.

Approximately 100 final-year radiography students from the University of Newcastle were invited to participate in a brief survey (Appendix 2). Sixteen responses were received. While the response rate was not high, it was encouraging to note that, 87.5 per cent had heard of BreastScreen NSW and there was a willingness to consider mammography and BreastScreen NSW as an employment option in the future. (Noteably, these responses should be treated with caution based on the response rate).

It would be helpful if radiographers were involved and informed of planning and decision-making for BreastScreen NSW. Often the information does not filter down to the radiographer and we are told what they think we need to know, so to have a more consultative process would be good radiographer survey respondent


Diagram 15: Final year radiography students

Those who would consider specialising in mammography see it as an interesting modality that is beneficial to the community. The new, evolving technology and the challenge of mammography were mentioned as good opportunities to increase skills.

While the results showed that respondents would consider working for BreastScreen NSW, they have a need to gain general experience early in their careers and are possibly seeking more variety than BreastScreen NSW can currently offer.

The results show that there is value is promoting BreastScreen NSW to radiography students. It is important that they are aware of the employment opportunities available, even if the knowledge is stored for future consideration, after they have broadened their skills.

I would love to work in a modality that values consistently high expectations with regard to image quality and patient care. I love the fact that the radiographer has the opportunity to have a significant impact on the patients’ experience and consequently encourage regular screening in the future University survey respondent

I would like to learn the basics of CT and be confident in all general radiography (including theatre and mobiles) before considering mammography University survey respondent


In order to capture a deeper insight on the BreastScreen NSW radiographer workforce, a number of people were interviewed, including SAS Directors, the NSW Chief Radiographer, and senior members of the BreastScreen NSW Coordination Unit. The format of these interviews and discussions was based on a SWOT (strengths, weaknesses, opportunities, threats) analysis of the radiographer workforce model. This considered the strengths and weaknesses of the current model as well as the opportunities and threats that may face this workforce in the future.

A summary of this SWOT analysis is outlined in Table 3 below, with a more in-depth commentary following.

Table 3: SWOT analysis

Strengths Weaknesses

• Structured work environment

• Flexibility of hours

• Nationally-recognised program

• Experts in mammography

• Ability to work for BreastScreen NSW and other provider/s

• Work conditions and award

• Work with predominately well women

• Repetitive role

• Limited opportunities to do other things

• Difficult to attract young radiographers

• Not perceived as an attractive specialty

• Isolated from other radiographers

• Ageing workforce

• Workforce model – 35 hours per week, Monday to Friday

• Difficulty attracting radiographers to rural sites

• Limited standardisation of processes

Opportunities Threats

• Improve career development of mammographers

• Rotate radiographers through BreastScreen NSW

• Form partnerships with other health providers

• Training and education

• Develop relationships with universities and promote BreastScreen NSW to radiographer students

• Tiered radiographer role

• Experienced radiographers mentor and develop new graduates

• Standardise processes, look for efficiencies and reduce waste

• Large portion of workforce likely to exit at the same time

• Not attractive to young radiographers

• Repetitive nature could lead to occupational overuse injuries

• One year post graduate mammography diploma

• Population growth

4. Interviews


There is flexibility and a lot of part time work, it suits women young and old sas director

Thanks to the ladies at BreastScreen NSW for a fast and friendly mammogram. In and out within 30 minutes. There’s no excuse to put this off. I’ve had my mammograms and ultrasounds with other providers in the past. This was my first with BreastScreen and they were fabulous Client compliment received august 2013

The clientele is appreciative; they come on their own free will for peace of mind, and it fosters a nice work environment sas director

4.1 Strengths

A key strength of the current radiographer workforce model is its structured working environment.

• BreastScreen NSW provides radiographers the opportunity to work regular Monday to Friday business hours.

• Some SASs provide weekend and after-hours services; however, there are no on-call requirements.

• Work is appointment-based so there are limited unscheduled requirements.

• There are few management responsibilities which reduces the complexities of the role.

While structure is important, BreastScreen NSW also provides flexibility with part-time work available within the radiographer workforce. This is seen as a particular strength for women returning to work after having children, and for an ageing workforce who may be looking to reduce their work commitments.

The strength of BreastScreen NSW is that it is part of a nationally-recognised program that provides a reputable and valued service to the community. The BreastScreen program is supported by rigorous accreditation standards and world-class digital technology where the priority is to maintain high quality radiography images. It is a rewarding career with the opportunity to make a difference in people’s lives through the early detection of cancer.

Radiographers have the opportunity to provide high-quality care that encourages and supports women to adopt recommended screening behaviours. BreastScreen NSW believes that if a woman has a positive experience at a screening mammogram she is more likely to return for her next screen.

Many radiographers work solely for BreastScreen NSW. This enables them to specialise in mammography and become an expert in this field. Focussing on only one discipline also means that there is not a requirement to keep up to date on a variety of equipment but rather, develop in-depth knowledge of specific equipment. They also work as part of a multidisciplinary clinical team and may have the opportunity to be involved in assessments.

Some radiographers make the most of working part time for BreastScreen NSW and work in other radiography areas the rest of the time. This enables them to keep up to date with other radiography disciplines.

BreastScreen NSW is seen to provide good training opportunities and provides an avenue for ongoing development and advancement in the areas of radiography assessment and sonography.

Another strength relates to the work conditions and award. The public sector is seen as having better conditions than the private sector. There is job security, comparable salaries, pleasant working environments and a maximum 35-hour working week for most BreastScreen NSW radiographers. Where applicable, there are allowances for working overnight and/or away from home in mobile units.

BreastScreen NSW offers radiographers an opportunity to work predominately with well women.


4.2 Weaknesses

There are weaknesses with the current workforce model that result in issues and challenges. It should be noted that some of these weaknesses have also been described as strengths.

The nature of the specialised screening radiographer role means that it can be very repetitive and, by working solely for BreastScreen NSW, radiographers can become too specialised. Many BreastScreen NSW radiographers only perform mammography which means other skills are not used or maintained, and they are not being exposed to other new technologies outside of mammography. There are limited opportunities to maintain and develop skills, such as biopsies. These factors can make it difficult to attract and recruit young radiographers as the role is seen as too specialised and/or limited in scope early in a career.

Anecdotally, it has been reported that the repetitive nature of the role may lead to repetitive injury which may be negated with a more mixed workload. No evidence has been collected to support or discount this however, it was raised by some as a concern. There are also limited options for radiographers to do something different within BreastScreen NSW if they no longer want a frontline role.

There is a concern by some that mammography is not perceived as an attractive specialty and is an area to move into later in one’s career. This perception could also make it difficult to attract new radiographers into the field.

BreastScreen NSW radiographers can be isolated from other radiographers as there is a minimal requirement to interact with others from different specialties.

As noted previously, more than 66 per cent of the radiography workforce is over 45 years of age with 33 per cent over 55, and a mean and median age of 50. Many enter BreastScreen later in their careers as they seek greater flexibility and less on-call work.

There is a continuing need to screen more women in increasing age bands, and to improve participation rates. The current radiographer workforce has already begun the move away from its traditional screening model. Digital imaging has been introduced, there is a need to be more accessible outside normal business hours and consumer needs are changing. The model of a 35-hour week, Monday to Friday, needs to continue to be reviewed. While there may be some reluctance to consider longer opening hours, staggered shifts and weekend clinics, the workforce model will need to continue to evolve to increase the number of screening episodes.

NSW is a large state with many remote areas that need to be covered by the BreastScreen program. Anecdotally, it is more difficult for the regional SASs to attract and recruit radiographers than it is for the metropolitan SASs. These remote areas also have the added challenge of delivering services through mobile units, which require radiographers to travel and stay away from home.

There is limited standardisation of processes and workforce models between SASs. Some of this is also driven by physical environment and specific LHD work practices. This means that it can be difficult for SASs to share resources and learn from others in terms of process efficiencies and improvements.

There is an expectation of workload and it is culturally hard to increase the expectation that they can do more, be more productive. There is no definition on how many screens one can do safely in one day sas director

It would be good if were easy to work for more than one SAS without needing a job vacancy to arise radiographer survey respondent


I have a young radiographer who does two days a week at BreastScreen and three days at a private practice – the mix of skills gives her the best of both worlds sas director

Take an initial period for radiographers to develop expertise but then we need to consider how they can expand and grow in the role. Create a multi- skilled workforce that can do mammograms, biopsies, 1st readings and ultrasounds sas director

4.3 Opportunities

There are opportunities and initiatives that could positively impact the radiography workforce model and future workforce strategies. A key area of opportunity noted was to understand the career development needs of BreastScreen NSW radiographers. This may include opportunities for developing reading, biopsy and sonographer skills to build a multi-skilled workforce.

To reduce the repetitive nature of the work and increase the appeal of mammography to a younger age group, avenues could be investigated for radiographers to rotate through BreastScreen NSW more readily. This could involve being more closely aligned to hospitals and/or private practices where radiographers could rotate through BreastScreen NSW and the service would have access to a larger workforce pool.

Training and education was seen as another area of opportunity for the future. Training needs to be more targeted and planned, allowing radiographers the opportunity to look at what training they would like to attend for the year ahead and how they would like to develop their skills. BreastScreen NSW radiographers have specific expertise and are a professional workforce which needs to be harnessed. Pathways could be developed for radiographers to support career development opportunities.(e.g. the opportunity to participate in, or undertake, some research activities).

There is an opportunity for BreastScreen NSW to consider how to improve its attractiveness to possible future employees. This may be achieved by actively promoting itself to radiography students and looking at how it can help these students spend some of their Professional Development Year (PDY) at BreastScreen NSW. Rather than focus on recruiting students directly from university, this could be done with a view to develop long-term relationships so that, when specialising in mammography may be an option, they are familiar with the BreastScreen program.

While there is an opportunity to look at how BreastScreen NSW can be attractive to a younger workforce, it is important to recognise that the nature of the work (and the opportunity for part-time hours) makes BreastScreen NSW attractive to women returning to work or reducing their workload later in life. This group is experienced and ready to specialise in the area of mammography; however, training, education and development opportunities also need to target this group.

It may be timely to start considering the role of the radiographer. There is currently an initiative to introduce a one-year post-graduate Mammography Diploma for people with a science/clinical background to spend one year developing the ability to do mammograms. This could bring new views, strengths and skills to the radiographer workforce.

In the United Kingdom, this profession has moved to a four-tier model, where different ‘tiers’ of radiographers are able to do different things. This is well established and comprises assistant practitioners working under supervision, registered radiographers, specialist and advanced practitioner radiographers and increasing numbers of consultant radiography practitioners, delivering imaging services.16


It appears the turnover of radiographers within BreastScreen NSW is low which implies a highly-experienced workforce. This experienced workforce could be encouraged to mentor and help develop new radiographers entering the BreastScreen NSW program.

Finally, there is an opportunity to consider how to improve and/or standardise the processes used within BreastScreen NSW. This may include adopting appropriate process improvement methodologies and considering how the current workforce can work smarter and be more efficient. When new technologies are introduced, processes should be reviewed to ensure the process achieves maximum best efficiencies with the new technology.

4.4 Threats

It is important to be aware of any predicted threats or known challenges that may impact the radiography workforce in the future.

A possible threat may be the age demographics of the current workforce. This is a threat if a large proportion of the workforce is likely to exit BreastScreen NSW at a similar time. Strategies will need to be explored to minimise this risk. Currently 32 per cent of the radiographer workforce is aged 55 or older. This means that in the next 10 years BreastScreen NSW could expect a similar or greater percentage to leave the workforce to retire or reduce their hours of work.

BreastScreen NSW is not highly attractive to young radiography graduates for a variety of reasons, including lack of breadth for experience and the challenging nature of mammography. It is seen as too specialised for new graduates with limited exposure to a variety of development opportunities. This could be an issue in the future if an ageing workforce continues to mature and exit in large numbers.

There is a perception that the repetitive nature of the role leads to occupational overuse injuries. This is an anecdotal threat that if realised will need to be minimised to ensure a healthy and active workplace.

The one-year post-graduate Mammography Diploma is seen by some as an initiative that may negatively impact future workforce strategies. Some feel it may diminish the value of a qualified radiographer as there is a perception that the diploma will be easier to obtain than a degree qualification. There is a possibility that this view may have a cultural impact on the radiographer workforce and create silos within the workforce on the basis of qualifications.

The ongoing expectation to screen more women through widening the target age brackets and improving participation rates will continue to challenge the BreastScreen NSW radiography workforce. Tensions between achieving targets, managing funding and providing a safe, responsive and quality work environment will need to be managed.

The future workforce is likely to include younger radiographers and/or radiographers who have trained in different ways. It will be important to consider different approaches in terms of training and education, staff management and workforce satisfaction for different groups. BreastScreen NSW should be considering how they can be an ‘employer of choice’ across the radiography workforce spectrum.

We will need a mature-age retention program – just because some radiographers are ageing, doesn’t mean they want to give up work. How do we keep the expertise? We also need to listen to GenY, what do they want as a workforce? sas director


5. Emerging themes and recommendations

This workforce strategy has explored many aspects of the BreastScreen NSW workforce:

• It has considered the general population, cancer and national workforces as well as political trends and influences.

• It has sought to understand the current BreastScreen NSW radiographer workforce (i.e. who they are, what they do and what they think).

• It has sough the views of potential future employees (radiography students).

• SAS Directors and senior staff involved with the BreastScreen NSW program have shared their views on the strengths and weaknesses of the radiography workforce, the opportunities that could have a positive future impact, and the threats that could challenge the future workforce model.

From all of this information, the following themes have emerged, as well as recommendations and strategies to address these.

5.1 Increasing population within the target age range

There is an increasing population in NSW, which means more women are going to require screening services in the future. The target age range has recently been increased and there is an ongoing commitment by the program to improve participation rates in line with national and statewide targets.

The BreastScreen NSW Coordination unit and SASs will need to work collaboratively to consider how to best provide quality services to this growing population. Consideration will need to be given to workforce numbers, hours of service, the number of clients that can reasonably be screened per day, and how processes can be re-engineered to maximise efficiencies while maintaining quality. This is explored further in 5.3 below. It is important to note that these strategies fit within a broader framework for improving screening numbers and participation rates across the State, such as improvements to technology, marketing and recruitment efforts, and business planning.

5.1.1 increasing population recommendations:• Forecast future eligible population and target age range trends by State

and by SAS, and understand the throughput required to achieve desired screening numbers and participation rates.

• Understand how these forecasts impact on workforce numbers and determine what workforce model will best meet increasing population requirements.

• Include other BreastScreen NSW strategies aimed at improving screening numbers and participation rates, to ensure that workforce is not looked at in isolation.


5.2 Generational workforce

This workforce strategy was commissioned due to concern that the radiographer workforce was ageing and would possibly be looking to exit the profession in large numbers in the next few years. The average age of BreastScreen NSW radiographers is 50 and therefore, the immediate risk of a large portion of the workforce exiting the program is reduced. However, there remains an urgency to understand the profile of the workforce and better understand the long-term workforce requirements.

BreastScreen NSW radiographers are a mature and experienced workforce. It is important that the value of their length of service and specialised knowledge is recognised and appreciated.

An older workforce might be seeking increased flexibility in terms of hours, the ability to manage the physical demands of their role and have less desire to pursue development opportunities. They also have a wealth of knowledge and experience, and possibly a desire to keep working for BreastScreen NSW for a number of years.

This workforce strategy was also initiated based on a concern that attracting new radiographers into BreastScreen NSW is difficult. Radiographers early in their careers are less likely to be interested in specialising in a modality that is perceived to limit their scope of practice. This is addressed in 5.4 below; however, BreastScreen NSW also needs to develop workforce models that attract and keep younger generations of radiographers.

It is believed that younger generations are more interested in the following drawcards regarding employment and employers.17 Many of these aspects are strengths of BreastScreen NSW and should be promoted when trying to attract new radiographers.

• Financial reward is important, but maintaining work-life balance tends to outrank financial considerations.

• The opportunity to work for a company or in an environment that fosters strong workplace relationships and inspires a sense of balance and/or purpose.

• Flexibility to more readily change jobs and relocate geographically.

• Jobs with flexibility and technology options that allow radiographers to work, and give them the opportunity to leave the workplace temporarily.

• Work is one component of a balanced life portfolio that includes family, friends, fitness and fun.

• Rapid career progression, diversity and challenging careers.


BreastScreen NSW needs to identify strategies to best manage and engage their valuable experienced workforce, while at the same time developing initiatives to attract new radiographers. “To keep good employees, you must meet their needs and expectations, and understand what keeps them inspired. Employees’ needs and expectations vary from one person to the next. They also vary depending on a variety of factors, including the generation of the workers. At this particular moment, there are several different generations – all with different worldviews, expectations and needs – in our workplaces.18”

5.2.1 experienced workforce recommendations:• Develop strategies to ensure experienced employees are retained and are

able to enhance their skillset. This will assist BreastScreen NSW in its ability to continually evolve and improve.

• Involve experienced radiographers in setting the direction for BreastScreen NSW by engaging their expertise and experience to develop appropriate strategies for improvement.

• Identify opportunities for training and development that match the needs of an already experienced workforce.

• Within the ‘Model of care’ recommendations below, identify opportunities for experienced radiographers to mentor and/or work in partnership with newer radiographers.

5.2.2 younger workforce recommendations:Develop strategies to ensure younger employees are attracted and retained. These strategies will include a workforce model that offers employees:

• challenging, varied work

• an environment that fosters a spirit of creativity and innovation

• recognition and reward for high performance and opportunities for advancement

• flexibility (in work schedules)

• mentoring opportunities

• organisational values that align with personal values

• the ability to balance personal and professional lives.


5.3 Model of care

A ‘Model of care’ can be defined as best practice care and services within a healthcare system for person or population group as they progress through the stages of a condition, injury or event19.

A model of care should include a workforce strategy, enabling an organisation to consider how they can have the right people in the right place at the right time to best achieve the organisation’s goals. In regards to BreastScreen NSW, this means having the right roles (radiographers and others) at the right sites (fixed and/or mobile, rural and metro) at times that best meet the needs of NSW women.

A key consideration here is the Radiographer Employment Award. There would be value in understanding why a 35-hour working week was originally introduced and whether these reasons are still valid. Aligned to this would be a review of how access to services can be enhanced through the ability to roster radiographers across the week.

There is currently a Certificate in Allied Health Assistance,20which covers workers who provide assistance to allied health professionals. Workers at this level operate under direct supervision and do not conduct programs or therapeutic interventions. There would be value in considering how this qualification could be used within BreastScreen NSW.

A model of care could consider the following:

• The women coming to BreastScreen NSW for screening need to be at the centre of any model of care.

• What service do they expect?

• How do you balance a quality personable level of care with achieving participation rates?

• What will radiographer and mammography roles look like in the future?

• Will roles such as radiographer assistant and advanced radiographer practitioners exist?

• How can BreastScreen NSW access the right number of radiographers in particular areas?

• How can radiographers be better rotated through the BreastScreen program (i.e. between SASs or shared with hospitals and/or private clinics)?

• Would a central pool of radiographers enable better placement of the workforce to where there is the greatest need at a specific time?

• How many screens and assessments can radiographers safely and effectively do in one day?

• What is the productivity requirement to ensure screening numbers are achieved and can the current workforce achieve this?

• What times should BreastScreen NSW be open for services?

• How does the program ensure that opening hours best meet the needs of the time-poor population?


5.3.1 Model of care recommendations:• Design flexible models of care for BreastScreen NSW that consider

how BreastScreen NSW needs to operate in the future to best meet the needs of NSW women.

• Within the model of care, BreastScreen NSW should consider

- the types of roles required to meet the program and client needs

- how to ensure quality-of-care is maintained while striving to achieve participation rates

- the ability to rotate, share and/or pool radiographers across BreastScreen NSW, between SASs and with hospitals and private practices ensuring ease of movement.

- what are the optimal hours of operation to meet client and program needs and how can radiographer rosters best support this ?

• Fully investigate the concept of tiered radiographer roles, considering what a tiered model would look like and what impact this would have on BreastScreen NSW.

• Review the Radiographer Award and determine if the premise for a 35-hour week is still applicable.


5.4 Mammography as a speciality

Mammography is a valuable radiography specialty, and the BreastScreen program relies on access to radiographers who are able to perform quality mammograms.

The very nature of a speciality requires a dedicated focus in a particular activity, (i.e. mammography). Feedback through this process indicates the repetitive nature of mammography is a negative. However, it needs to be stated and understood that the workforce that BreastScreen NSW requires, and provides opportunities for, is radiographers who perform mammograms.

Specialising in mammography can be considered by some as ‘too specialised, too soon’ for new graduates. Graduates are looking for breadth of experience over a range of modalities. However, it is important for BreastScreen NSW to be on the radar of new graduates and those in the early stages of their radiography career, promoting the benefits of BreastScreen and mammography for future consideration.

As noted, partnerships and shared resources with hospitals and/or private clinics would allow for radiographers to specialise in mammography with BreastScreen NSW while maintaining other modality skills and experience. This could make working at BreastScreen NSW more attractive, as well as reducing the perceived repetitive nature of mammography.

A valuable exercise could be to consider what the career pathway and competency framework of a radiographer specialising in mammography looks like. For example is there an optimal pathway that leads to specialising in mammography as well as a logical pathway that stems from specialising in mammography (e.g. ultrasound)? This may assist with planning how BreastScreen NSW and the specialty of mammography are promoted to the general radiography population who are considering mammography.

5.4.1 Mammography specialty recommendations:• Identify and develop relationships between BreastScreen NSW and

universities with radiography programs. Investigate the possibility of involvement in career days, clinical placements and the ability for graduates to spend some of their National Professional Development Program at BreastScreen NSW.

• An outcome from the model of care exercise in 5.3.1 should be to look at partnerships with hospitals and/or private clinics where resources can be shared, or access can be gained to a larger pool of radiographers who can rotate through the BreastScreen program.

• Develop a career pathway and competency model for radiographers who are specialising in mammography (or considering it).


5.5 Optimal processes

BreastScreen Australia National Accreditation Standards (NAS) (2008)21 require services to ensure that all screening and assessment units use common policies, protocols and procedures. In early 2013, BreastScreen NSW introduced a set of Operating Standards for the Coordination Unit and SASs, which includes documented clinical policies, clinical guidelines and quality assurance programs that support BreastScreen NSW. Both the NAS and the Operating Standards provide clinical and quality assurance guidelines.

Currently there is limited standardisation of processes across the eight SASs. Consideration should be given to how standardisation could lead to optimal processes and process efficiencies.

It is important that when changes occur to one part of a process (e.g. new technology), the whole process (and any supporting processes) are reviewed to determine if the change could lead to wider process improvements and efficiencies.

BreastScreen NSW should undertake a process review exercise looking at how these can be best optimised across SASs. This could identify models of desired work practice and standardised work processes that lead to optimal workforce models. Process improvement should incorporate methodologies that look at how to work smarter, as well as consider how best to achieve a healthy and active workplace.

These process reviews should also become standard practice whenever new initiatives and technologies are introduced. Implementation of new initiatives should include a wider process review to ensure efficiencies are achieved.

5.5.1 optimal process recommendations:• Consider how processes can be standardised across SASs.

• Apply and provide training in lean thinking or a similar methodology (where appropriate) to ensure processes are efficient and waste is reduced.

• Any process review should consider the impact of tasks on occupational health and safety concerns, with a goal of having a healthy and active workplace. It should also explore effectiveness and efficiency.

• A policy should be established that ensures any new technology and/or changes to existing processes are not implemented in isolation, but consider how efficiencies and improvements can be made throughout the wider process.


5.6 Training and development

A NSW Public Sector Capability Framework22 has been developed by The NSW Public Service Commission. It describes the capabilities and associated behaviours that are expected of all NSW public sector employees, and is based on the premise that, central to workforce performance are the capabilities, the knowledge, skills and abilities – that employees must demonstrate to perform their roles effectively.

Two of the areas this framework supports is targeted learning and development activities (formal and informal) to specific capability levels and underpinning talent management programs and individual career planning, enabling employees to identify career and development pathways based on the capabilities required for progression to chosen roles.

Training and development, and career pathways have emerged as key themes through this workforce strategy process.

A common theme is for an improved program of training and development. A program of planned training and education, scheduled in advance has been suggested. Radiographers want to be able to plan what training and education they attend during the year and management.

Training and development should provide occasions to network with other radiographers outside of one’s own SAS, and take into account the part-time workforce (ensuring training days are varied by day of week and time of day). It is important that if required, training is individually tailored, focusing on mentoring, clinical supervision and support.

Improved access to research, training and education, career development succession planning, and a broader scope of practice have been eluded to through this process. There is an opportunity to strengthen the role of professional leadership for the radiographer workforce. It is also worth considering the roles of tutor radiographers and how these can best add value, and ensure succession planning for senior positions.

5.6.1 training and development recommendations:

• Develop an annual program of training and education for BreastScreen NSW radiographers.

• Support the process of gaining CPD.

• Identify ways that networking and knowledge can be shared between SASs.

• Implement individual development plans for all radiographers. Link this to the career pathway, individual goals, and the annual program of training.

• Strengthen professional leadership roles, consider how tutor radiographers can best add value and be supported to do this, and develop succession planning for senior positions.


Based on the information documented in this strategy, it has been identified that the following focus areas and actions will enable BreastScreen NSW to consider what future radiographer workforce models and initiatives are required to meet the future requirements of the Program.

This will help to ensure NSW women in the target age group have access to screening and assessment services, and that participation rates within these target age groups are maximised.

This section outlines the key actions BreastScreen NSW will take in relation to the identified focus areas. The BreastScreen NSW Coordination Unit and each SAS should consider these recommendations and actions, and develop an implementation plan to develop these further. This Radiographer Workforce Strategy is a living document and should continue to be reviewed and updated. It is recommended that an evaluation be conducted after 24 months to review progress and implementation.

6.1 Increasing population within the target age range

Recommendation Actions

1. Understand the throughput required to achieve desired screening numbers and participation rates

• Forecast future eligible population and target age range trends by State and by SAS.

2. Determine what workforce model will best meet increasing population requirements

• Calculate how the above forecasts impact on workforce numbers and hours of service.

3. Ensure that workforce in not looked at in isolation

• Align with other strategies aimed at improving screening numbers and participation rates.

6. Action plan


6.2 Generational workforce


1. Retain experienced employees to ensure the health of the workforce and its ability to continually change and improve

• Involve experienced radiographers in setting the direction for BreastScreen NSW.

• Identify opportunities for training and development that match the needs of an experienced workforce.

• Within the model of care recommendations opposite, identify opportunities for experienced radiographers to mentor and/or work in partnership with newer radiographers.

2. Attract and retain younger employees • Develop strategies to ensure younger employees are attracted and retained. These strategies will include a workforce model that offers employees:

- challenging, varied work - an environment that fosters a spirit of creativity and innovation - recognition and reward for high performance and opportunities

for advancement - flexibility (in work schedules) - mentoring opportunities - organisational values that align with personal values - the ability to balance personal and professional lives.

6.3 Model of care


1. Design a flexible model of care for BreastScreen NSW

• Consider how BreastScreen NSW needs to operate in the future to best meet the needs of NSW women, including:

- the types of roles required to meet the program and client needs;

- ensuring quality of care is maintained while striving to achieve participation rates;

- the ability to rotate, share and/or pool radiographers across BreastScreen NSW, between SASs and with hospitals and private practices, ensuring ease of movement;

- identifying the optimal hours of operation to meet client and program needs.

• Review the Radiographer Award and determine if premise for a 35-hour week is still applicable.

2. Investigate the concept of tiered radiographer roles

• Consider what a tiered model would look like and what impact this would have on BreastScreen NSW and the radiographer workforce.


6.4 Mammography as a speciality


1. Identify and develop relationships between BreastScreen NSW and universities with radiography programs

• Investigate the possibility of involvement in career days, clinical placements and the ability for graduates to spend some of the NPDP at BreastScreen NSW.

2. Ensure the model of care considers partnerships with other providers of radiographers

• Investigate opportunities to form partnerships with hospitals and/or private clinics where resources can be shared, or access can be gained to a larger pool of radiographers who can rotate through the BreastScreen program.

3. Develop a career pathway and competency model for radiographers who are specialising in mammography

• Develop a career pathway and competency model for radiographers who have specialised in mammography, and are looking for further development.

• Develop a career pathway and competency model for radiographers who are considering specialising in mammography (e.g. what do they need to do beforehand?).

6.5 Optimal processes


1. Consider how processes can be standardised across SASs.

• Ensure new technology and/or changes to existing processes are not implemented in isolation

• Consider how efficiencies and improvements can be made throughout the broader process.

2. Ensure processes are efficient and waste is reduced

• Apply, and provide training in, lean thinking or a similar methodology where appropriate.

3. Any process review should with a goal of having a healthy and active workplace

• Consider the impact of tasks on occupational health and safety concerns.


6.6 Training and development


1. Develop an annual program of training and education for BreastScreen NSW radiographers

• Advertise and plan training ahead of time so radiographers can select and schedule as appropriate/relevant.

• Support the process of gaining CPD.

• Identify ways that networking and knowledge can be shared between SASs.

2. Implement individual development plans for all radiographers

• Link this to the career pathway, individual goals, and the annual program of training.

3. Develop a strong model for leadership (training and development)

• Strengthen professional leadership role, consider how tutor radiographers can best add value and develop succession planning for senior positions.


Introduction

BreastScreen NSW is in the process of developing a Workforce Planning Strategy to clearly understand the BreastScreen NSW’s radiographer workforce and its requirements for the future. This will allow BreastScreen NSW to consider what factors will impact this workforce in the future, and what strategies will be required to ensure that the workforce allows BreastScreen NSW to meet its ongoing goals and objectives, and be prepared for future challenges.

The purpose of this survey is to capture some additional information about how radiographers view BreastScreen NSW and whether or not radiographers are interested in future training and education opportunities.

1. What are the positives of working with BreastScreen NSW?

(Please rank in order of importance with 1 being most important)

Flexible work hours

Digital technology

No on call hours

Perform screening & assessments

Specialising in mammography

Salary

BreastScreen NSW Reputation

NAS Standards

2. What are the negatives of working with BreastScreen NSW?

(Please rank in order with 1 being the most negative aspect)

Repetitive nature of work

Limited scope of practice

Salary

Work in mobile vans


Occupational Health & Safety issues


Limited ability to maintain skills

3. On a scale of 1 – 5, how satisfied are you with working for BreastScreen NSW?

1 2 3 4 5 Very unsatisfied Very satisfied

4. If your answer to question 3 above was “3 or less”, what would need to change to improve your work satisfaction?

Please comment:

Appendix 1: Radiographer survey


5. If you have worked with BreastScreen NSW for more than 5 years, why have you stayed?

Flexible work hours

Digital technology

No on call hours



Salary


Nowhere else to go

Other (please state):

6. What attracted you to come to BreastScreen NSW?

(Please rank in order of importance with 1 being most important)

Flexible work hours

Digital technology

No on call hours



Salary


Work in mobile sites

7. What is your highest level of qualification you have attained?

Diploma Degree

Masters PhD

Other

8. Are you interested in obtaining further qualifications?

No

Yes – Please provide details:

9. Are you interested in further educational opportunities?

No


10. Would you be interested in pursuing Research opportunities with BreastScreen NSW?

No


11. Which of the following comments best reflects you?

(Please select as many as are applicable)

I get satisfaction from providing a much needed service to women

It is important to me to provide excellent customer service so that women return for future screens

I like working with up to date technology

I want to continue developing my skills as a radiographer

I believe my specialised knowledge in mammography should be valued

12. Do you have any other comments or initiatives you would like to suggest in regards to the Radiographer Workforce Strategy and possible requirements for the future?


Student Survey

1. Have you heard of BreastScreen NSW?

Yes No

2. Have you considered specialising in mammography?

Yes – If so why?

No – If not why not?

3. Have you considered employment opportunities with BreastScreen NSW?

Yes – If so why?


4. Would you consider spending time at BreastScreen NSW as part of your NDPD?

Yes – If so why?


5. What considerations are important to you when considering future employers?

Please comment:

6. Would you be interested in receiving further information about career opportunities at BreastScreen NSW?

Yes - Please provide your email address:

No

Appendix 2: University survey


1. Watson Wyatt:Workforce Planning – Making organizations more agile. http://www.watsonwyatt.com/asia-pacific/pubs/perspective/docs/Feb2009/09Winter_Org_Trends.pdf.Viewed October 2013

2. Business Dictionary. http://www.businessdictionary.com/definition/workforce-planning.html. Viewed October 2013

3. Australian Government, Department of Health and Ageing: BreastScreen Australia Evaluation Final Report, June 2009.

4. Health Workforce Australia: National Cancer Workforce Strategic Framework, May 2013 p.10.

5. NSW Government,NSW Cancer Plan 2011-2015.

6. Australian Bureau of Statistics, Catalogue Number 3235.0 - Population by Age and Sex, Regions of Australia, 2011.

7. NSW Ministry of Health: Projected population data for the designated years from the Epidemiology and Surveillance Branch

8. Cancer Institute NSW. http://www.cancerinstitute.org.au/cancer-in-nsw/cancer-presentation-slides.Viewed October 2013

9. Cancer Institute NSW.http://www.cancerinstitute.org.au/cancer-in-nsw/cancer-presentation-slides. Viewed October 2013

10. Armstrong BK, Gillespie JA, Leeder SR, et al:Challenges in the health and health care for Australia.Medical Journal of Australia 187 (9): 485-489, 2007.

11. Department of Health, NSW. Discussion with Cathy Ellis, 19 June 2013

12. Australian Institute of Radiography:National Professional Development Programme.http://www.air.asn.au/cms_files/07_ClinicalTraining/01011_Guide_NPDP.pdf .Page 5. Viewed October 2013

13. HETI.Information sourced verbally 5 June 2013

14. Industrial Relations Commission of NSW: Health Employees’ Medical Radiation Scientists (State) Award , variation effective 2.7.2012

15. Industrial Relations Commission of NSW: Health Employees’ Medical Radiation Scientists (State) Award, variation effective 2.7.2012

16. The College of Radiographers:Implementing Radiographer Career Progression: Guidance for Managers, May 2005.http://www.improvement.nhs.uk/documents/18weeks/career-progression.pdf. Viewed October 2013

17. David Stanley, N u r s D , MSc HS , B a N g , Di p HE ( N u r ) , R N , RM, T F , Ge r o n t i c Ce r t:Multigenerational workforce issues and their implications for leadership in nursing. Journal of Nursing Management 18: 846-852 ,2010

18. HR Council Canada. http://hrcouncil.ca/hr-toolkit/diversity-generational.cfm.Viewed October 2013

19. Department of Health Western Australia. WA Health Networks: Model of Care and guidelines – Ensuring people get the right care , at the right time, by the right team and in the right place, p4

20. Australian Government.Qualification details HLT42512 – Certificate IV in Allied Health Assistant (Release 2).http://training.gov.au/Training/Details/HLT42512. Viewed October 2013

21. BreastScreen Australia.National Accreditation Standards, Performance Objective 4.6, p102

22. NSW Public Service Commission: NSW Public Sector Capability Framework. http://www.psc.nsw.gov.au/Sector-Support/Capability-Framework.Viewed October 2013

References

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Tel: +61 2 8374 5600 Fax: +61 2 8374 3600

Email: [email protected]

www.cancerinstitute.org.au

BreastScreen NSW Radiographer Workforce Strategy · 4 BreastScreen NSW Radiographer Workforce Strategy Executive summary This Radiographer Workforce Strategy was commissioned to develop

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