The use of ICT and Management Practices and its contribution to productivity in Acute Healthcare Trusts

Patrick DunleavyLeandro CarreraJane Tinkler

What factors influence productivity in healthcare trusts?

Quality of doctors, nurses etc Quality/modernity of buildings Medical/nursing staff training, culture and morale Non-medical staff training, culture and morale Investment in research and development, R & D

spending Modernity/efficacy of medical equipment, drugs

and treatments being used The organization of patient work-flows Overall organizational leadership/ top culture Management and administrative support

processes ICT use

Understanding the contribution of ICT use and management to productivity

Previous work in the private and the public sector has suggested that both factors can interact in specific ways to contribute to productivity (Bresnahan et al 2002; Garicano and Heaton 2007)

Typically, scholars have relied on surveys to measure ICT use and Management practices, but Generating full responses is often a problem Responses show a bias towards “correct”

answers

Organization represents itself online as doing

Organization is actually doing

A lot A little

A lot 1. Web census analysis correctly identifies situation

2. Façade activity

Not much 4. Organizations with ‘stealth’

activities

3. Web census analysis correctly identifies situation

Organizations’ underlying pattern of activities can be mapped from their online presence

Tracking Management Practices

Included 41 indicators

Covering 7 key dimensions

Max possible score = 43

DIMENSION INDICATORS

Patient Interaction and Information

6

Patient Empowerment Features

4

Outreach Information for Local Community

8

Trust Accountability and Ethos

6

Performance Tracking / Standards

8

Managing and Recruiting Talent

6

Human Resource Development

3

Management Index: How Acute Trusts perform (N=166)

01

02

03

04

0

Trusts

Man

agem

ent

Sco

re

Median1st Quartile

3rd Quartile

Tracking hospital trusts’ ICT use

Included 18 indicators

Covering 4 key dimensions

Max possible score = 22

DIMENSION INDICATORS

Online Information / Documentation

4

Good Practice on Website ICT Features

6

Web Usability 4

IT Innovations 4

ICT use Index. How Trusts perform (N=166)

0

2

4

6

8

10

12

14

16

18

Trusts

IT S

co

re

3rd QuartileMedian

1st Quartile

Measuring Labour Productivity in NHS Trusts

•Outpatient Appointments

•Inpatient Spells

Cost and Quality

Medical Staff Headcount

Input

Output

Productivity

Adjusted for

Output measure cost adjustment

We collected data on Inpatient spells and outpatient appointments for 166 Acute Trust

Data was adjusted using cost weights based on unit costs (Curtis 2008; Castelli et al. 2007)

Output measure quality weighting

To account for the quality of the service provided, the output measure was further adjusted by:

Mean waiting time Complaints completion ratio Patient satisfaction

For each adjusting measure, we created a five-interval scale with a percentage adjustment value that varied from 0% to 100%

The output value for each Trust was then multiplied by the respective adjustment percentage

Mean waiting time adjustment

The five-point adjustment scale was based on the 18 weeks maximum waiting target set by the NHS

MEAN WAITING TIME

PERCENTAGE QUALITY ADJ.

DISTRIBUTION OF TRUSTS

> 126 0% 2%

≤ 126 > 94.5 25% 13%

≤ 94.5 > 63 50% 61%

≤ 63 > 31.5 75% 20%

≤ 31.5 100% 4%

Mean patient satisfaction adjustment

Adjustment based on NHS data on patient satisfaction to five different questions ranging from 1 (“not satisfied”) to 5 (“satisfied”)

MEAN PATIENT SATISFACTION

PERCENTAGE QUALITY ADJ.

DISTRIBUTION OF TRUSTS

>4 100% 2%

> 3 ≤ 4 75% 84%

> 2 ≤ 3 50% 12%

> 1 ≤ 2 25% 2%

≤ 1 0% 0%

Mean complaints completion adjustment

The adjustment was based on the mean ratio of complaints completed to the 25 working days NHS target

COMPLAINTS COMPLETION RATIO

PERCENTAGE QUALITY ADJUSTMENT

DISTRIBUTION OF TRUSTS

>0.85 100% 35%

> 0.7 ≤ 0.85 75% 41%

> 0.55 ≤ 0.7 50% 15%

> 0.4 ≤ 0.55 25% 6%

≤ 0.4 0% 3%

NHS Trusts cost and quality adjusted output

0

20000

40000

60000

80000

100000

120000

140000

160000

180000

200000

Trusts

Co

st a

nd

Qu

alit

y A

dju

sted

Ou

tpu

t

Median

1st Quartile

3rd Quartile

Labour productivity across NHS Trusts(based on cost & quality-adjusted output)

0

50

100

150

200

250

300

350

400

450

Trusts

Pro

du

ctiv

ity

(Ou

tpu

t p

er M

edic

al H

ead

cou

nt)

Median

1st Quartile

3rd Quartile

Picturing the direct relationship between IT use and output levels (before controlling for other variables)

Picturing the direct relationship between management practices and output levels (before controlling for other variables)

Analysing the contribution of Management and ICT to Productivity

OLS Estimates on Labour Productivity

Independent VariableCost Weighted

ProductivityCost and Quality

Weighted Productivity

IT Use 4.45

11.31

35.71**

18.41

Management Practices -0.77

4.73

12.86*

7.76

Interaction Term -0.27

0.47

-2.06***

0.04

General Training 1.48

5.29

12.19

8.86

Specialist -24.44

18.62

109.63***

32.18

Teaching -33.16

29.65

49.29

50.71

London -54.21***

16.4

-80.28***

26.73

R2 0.21 0.23

N 147 147

Preliminary Results

Specialist and non-London based trusts are positively associated to cost and quality adjusted productivity

Results seem to indicate that ICT and Management have a positive effect on productivity when the other variable in the interaction term is zero

The interactive results of ICT and Management require further graphical interpretation to view how ICT impacts on productivity conditional on Management values and vice-versa (how Management impacts on productivity given specific values of ICT)

The effect of ICT on productivity conditional on Management Practices values

The effect of Management on productivity conditional on ICT values

Conclusions and insights for further work

Data from the graphs seem to show that ICT is beneficial for Trusts with low to medium-low levels of Management to improve productivity.

Management seems to be less important to improve productivity

Yet, these are preliminary results and they may indicate that Productivity is just one of the key factors to consider when assessing NHS Trusts’ capacity to employ resources efficiently and innovate, but not the only one

Still, our research shows the importance of trying to think of new unobtrusive ways to measure key factors such as ICT, Management Practices and their relationship to productivity. It also points out the importance of modelling the combined effect of ICT and Management Practices on productivity

Thank you!