Improving trauma imaging in Wales through Kotter's theory of change

•The practice of Trauma CT in Wales initially did not meet RCR guidance.•Kotter's theory of change was utilised to improve standards.•A superior quality of trauma imaging is now available across Wales.

AimTo improve the practice of trauma computed tomography (CT) within Wales using recognised leadership techniques for change.Materials and methodsRoyal College of Radiologists' (RCR) guidance, in addition to other key recent evidence, were used to form an aspirational standard. All centres across Wales with a major emergency department were included. Kotter's theory of change was utilised to facilitate an improvement in practice across the region, with larger units prioritised initially.ResultsOf the 13 major emergency units in Wales, eight centres had no formal trauma CT protocol. Only one centre utilised the Bastion protocol (in comparison to 75% of major trauma centres). After the campaign to improve trauma imaging, seven centres now offer the Bastion protocol, with currently only three peripheral centres still without a procedure for whole-body CT. The two largest centres have implemented an emergency department pro forma.ConclusionTrauma CT within Wales has significantly improved as a result of this project. Kotter's theory is demonstrated as an effective tool for facilitating a change in practice on a regional/national scale.