The Blacktown Mt Druitt Hospital Imaging Department wanted to find a clinical practice improvement solution to the escalating endemic and common public hospital problem of long waiting times for x-rays, Access Block, cancelled examinations, inefficiency and poor service capacity. A multi-disciplinary team was formed, the workflow analyzed, request form and patient flow were mapped from time of requesting the x-ray examination to final report delivery. After the main causes were identified the steps deemed unnecessary were eliminated to create a revised request pathway (arriving with patient instead of prior) and patient flow. Patients arriving with the request form were given immediate access. Radiographers from other modalities methods provided support to ensure streamlined patient flow within the department. Patient Services Assistant (PSA) roles were redefined and the referring ward became responsible for contacting the PSA when patient was ready to be transported. This new process was called 'Open Access'. The issues identified were receiving and distribution of the request form to imaging areas providing x-ray service and the excessive, uneven workflow demands of the PSA. As a result of original request form pathway and the patient flow system, radiographers were inefficient and underused, many examinations were cancelled, service capacity was poor and imaging contributed to hospital Access Block. Through implementation of 'Open Access', average ward x-ray availability reduced from 15 to 1 h, with 91.9% of all examinations completed in less than 3 h. Average Emergency Department x-ray availability reduced from 3 h to 30 min. Average of 80 cancelled x-ray examinations/month reduced to zero. Patients requiring x-ray have immediate access to services when they arrive with the request form. 'Open Access' has led to efficient patient flow, improved availability of images, assisted patient clinical management, discharge processes from hospital and bed availability. 'Open Access' has reduced Emergency Department Access Block, allows more effective use of staff resources and higher staff, patient and referring ward satisfaction.