Exploring how ownership models of radiological services affect operational practices in South African private hospitals

Abstract

Radiology plays a critical role in diagnostic pathways within private hospitals in South Africa, yet limited empirical research has examined how ownership models influence operational practices in this sector. This study examined the differences between radiologist-owned practices and hospital-owned radiology departments, focusing on how each model affects workflow efficiency, decision-making autonomy, resource utilisation, quality assurance, and patient outcomes. A qualitative research design was employed, using semi-structured interviews with twelve participants representing clinical, administrative, and managerial roles across two ownership models. Data were analysed thematically, guided by Resource-Based View (RBV), Institutional Theory, and Contingency Theory. Findings revealed distinct operational performance patterns shaped by ownership transparencies. Radiologist-owned practices demonstrate agility, rapid decision implementation, and personalised patient care driven by clinician authority. However, these strengths come with limitations in capital investment, workforce resilience, and formalised compliance systems. Hospital-owned radiology departments offer stability, advanced digital integration, structured governance, and accreditation readiness; however, they often experience slower responsiveness and reduced frontline operational autonomy due to bureaucratic processes. The study concluded that no ownership model is universally superior; instead, each is optimal under specific environmental demands. Radiologist-owned agility suits are suitable for lower-volume and semi-rural contexts, while hospital-owned standardisation supports high-volume, regulated environments. Practical recommendations are proposed for radiology leaders, investors, and policymakers, emphasising hybrid strategies that combine clinical agility with organisational system support, particularly in preparation for the National Health Insurance (NHI) transformation in South Africa. The research contributes new operational insights to the limited literature on radiology ownership models and underscores the need for strategic alignment between ownership, organisational capabilities, and service context.