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!