The use of ICT and Management
Practices and its contribution to
productivity in Acute Healthcare
Trusts
Patrick Dunleavy
Leandro Carrera
Jane 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
Organizations’ underlying pattern of
activities can be mapped from their
online presence
Organization is actually doing
Organization
represents itself
online as doing
A lot
Not much
A lot
A little
1. Web census
analysis correctly
identifies situation
2. Façade activity
4. Organizations
with ‘stealth’
activities
3. Web census
analysis correctly
identifies situation
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
40
Management Index: How Acute Trusts
perform (N=166)
Median
10
20
1st Quartile
0
Management Score
30
3rd Quartile
Trusts
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)
18
16
14
3rd Quartile
Median
12
IT Score
1st Quartile
10
8
6
4
2
0
Trusts
Measuring Labour Productivity in NHS
Trusts
•Outpatient
Appointments
•Inpatient
Spells
Output
Adjusted for
Productivity
Cost and Quality
Medical Staff
Headcount
Input
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 fiveinterval 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
200000
Cost and Quality Adjusted Output
180000
160000
140000
120000
100000
3rd Quartile
80000
Median
60000
1st Quartile
40000
20000
0
Trusts
Labour productivity across NHS Trusts
(based on cost & quality-adjusted output)
Productivity (Output per Medical Headcount)
450
400
350
300
250
3rd Quartile
200
Median
150
1st Quartile
100
50
0
Trusts
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
Cost Weighted
Productivity
Cost 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
-54.21***
16.4
-80.28***
26.73
R2
0.21
0.23
N
147
147
Independent Variable
London
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!