The development of good
management practices and ICT
use in NHS Hospital Trusts
Patrick Dunleavy,
Leandro Carrera and
Jane Tinkler
How to measure Management and ICT
use within the NHS?


It’s vitally important that the NHS does
patient care in an organization for service
delivery that is as efficient as possible,
using management good practice and
modern ICTs
Previous researchers have relied on
surveys of trusts to tap progress on these
fronts, 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
15 Indicators of good management
practices found in most hospital trusts
Web-census Indicator
Link to press releases
Trust board minutes provided
Financial Report updated
List of Trust board future / past meetings provided
Links to individual hospitals
NHS Direct link available
Biography of directors provided
Trust phone lists available
Mention to Care Quality Commission
Link to Trust charity available
Link to the communications team
Link to Annual Health check
Information on the benefits of working in the trust
Annual audit letter available
Information on Trust history
Number of
Trusts
% Coverage
140
139
136
133
129
125
122
120
119
116
116
115
115
114
111
84
83
81
80
77
75
74
72
72
70
70
69
69
68
67
15 indicators of management practices
present in around half of hospital trusts
Web-census Indicator
Information on volunteering positions
Trust board agenda informed
Link to performance documentation
Hospital infrastructure link
Information on how to cancel appointments
Information on learning possibilities for non-medical
staff
Infection rates provided
MRSA statistics provided
Recent developments on trust performance
News on each hospital available
Is the website still mentioning the Healthcare
commission?
Trust organigram provided
Information on programmes or placement for student
placements
Link to Care Quality Commission report on the trust
Information on Trust mission
Number of Trusts
% Coverage
106
104
102
100
93
64
63
61
60
56
93
56
89
89
88
86
54
54
53
52
83
50
82
49
82
49
80
79
48
48
15 Indicators of management practices
not found in most hospital trusts
Web-census Indicator
Information on Trust values
Information on Trust goals
FOI link available from the home page
Information about flexible approach to work provided
Dedicated Research & Development section
Information on moving to the area provided
Care Quality Commission’s summary statistics on the
trust provided
Link to events organised by the trust
Hygiene code report available
Caldicott Guardian name provided
Centre for Postgraduate Professional education
PALS representative name provided
Complaints manager name provided
Links to PCT in the area
Information on Trust pay scales
Number of Trusts
% Coverage
78
72
69
69
68
64
47
43
42
42
41
39
56
34
55
54
49
45
39
35
34
13
33
33
30
27
24
21
21
8
Management Practices Index


We included
45
indicators
covering 11
dimensions
Dimensions
were
weighted to
reflect
relative
significance
for good
managemen
t practice
DIMENSION
INDICATORS
% WEIGHT
Key partners
Performance
About the Trust
and its Board
Corporate
Documents
HR: Work for Us
HR:Training
Care for Patients /
Visitors
Care: Contacting
Care: Values
Marketing: About
Us
Marketing: News
2
9
18%
18
5
12
3
12
6
3
8
8
4
8
4
3
4
4
3
4
3
4
Management Practices: Frequency
distribution
0
OXFORD
MILTON KEYNES
NUFFIELD
NORTH WEST
EAST AND NORTH
BASINGSTOKE
ROYAL
WRIGHTINGTON,
UNITED BRISTOL
SHEFFIELD
IMPERIAL NHS
MUSGROVE PARK
CHELSEA AND
ROYAL DEVON
NORTH CUMBRIA
MAIDSTONE AND
BASILDON AND
WEST DORSET
BRIGHTON AND
ALDER HEY
ST HELENS AND
SHERWOOD
ROYAL
KING'S COLLEGE
DONCASTER AND
WEST SUFFOLK
WINCHESTER
EAST CHESHIRE
BLACKPOOL,
LANCASHIRE
AINTREE
3
WHIPPS CROSS
LIVERPOOL
UNIVERSITY
Management Score
Management Practices: How Trusts
perform
4.5
4
3rd Quartile
3.5
Median
1st Quartile
2.5
2
1.5
1
0.5
Top performers in Management
Practices
TRUSTS
SCORE
OXFORD RADCLIFFE HOSPITAL NHS TRUST
4.0
UNIVERSITY HOSPITAL OF NORTH STAFFORDSHIRE NHS
TRUST
3.9
CALDERDALE AND HUDDERSFIELD NHS TRUST
3.8
PLYMOUTH HOSPITALS NHS TRUST
3.7
EAST KENT HOSPITALS NHS TRUST
3.7
MILTON KEYNES GENERAL HOSPITAL NHS TRUST
3.6
PETERBOROUGH HOSPITALS NHS TRUST
3.6
EPSOM AND ST HELIER NHS TRUST
3.6
BEDFORD HOSPITALS NHS TRUST
3.6
ADDENBROOKE'S NHS TRUST / CAMBRIDGE UNIVERSITY
HOSPITALS
3.6
Low performers in Management
Practices
TRUSTS
SCORE
MAYDAY HEALTHCARE NHS TRUST
1.7
LEWISHAM HOSPITAL NHS TRUST
1.7
ROTHERHAM GENERAL HOSPITALS NHS TRUST
1.7
LIVERPOOL WOMENS HOSPITAL NHS TRUST
1.6
NORTHERN LINCOLNSHIRE AND GOOLE HOSPITALS NHS TRUST
1.6
HEREFORD HOSPITALS NHS TRUST
1.5
NEWHAM HEALTHCARE NHS TRUST
1.5
COUNTESS OF CHESTER HOSPITAL NHS TRUST
1.4
SOUTH TYNESIDE HEALTH CARE NHS TRUST
1.4
UNIVERSITY HOSPITAL OF SOUTH MANCHESTER NHS
1.3
ICT use Index

We included
22 indicators
divided in 3
dimensions
DIMENSION
Online Information-giving
INDICATORS
11
Services are Internet
Accessible
7
Website Useability
4
Indicators of good ICT practice
present in most hospital trusts
Number of
Trusts
% Coverage
Search engine works properly
132
80
Not more than 15 items in menu
130
78
Web pages updated
125
75
Donations link available
113
68
Site map available
104
63
Web-census Indicator
Indicators of good ICT practice
present in around half of hospital
trusts
Number of
Trusts
%
Coverage
Possible to change the font size
85
51
Link to Adobe PDF Reader
82
49
Web accessibility link provided
79
48
Waiting times provided
78
47
Link to NHS Choices
77
46
Mention of IT Expenditure
65
39
Possible to manage appointments online
63
38
Technical aspects (videos, pod casts) available
58
35
Website comment box available
55
33
Web-census Indicator
Indicators of good ICT practice not
present in most hospital trusts
Number of
Trusts
% Coverage
Appointment management as part of Choose
and Book
49
30
Web page dated
39
24
Less than 7 items in menu
35
21
Link to Annual Report from the home page
IT Strategy Document is older than three years
32
28
27
19
17
16
IT Strategy Document Available
25
15
9
5
Web-census Indicator
Possible to change the background colour
Pop-up web survey
ICT use: Results
0
ESSEX RIVERS
OXFORD
PENNINE ACUTE
Liverpool Heart and
NORFOLK AND
HULL AND EAST
ADDENBROOKE'S
ROYAL BERKSHIRE
POOLE HOSPITALS
WINCHESTER AND
NORTHERN DEVON
CHRISTIE HOSPITAL
WALTON CENTRE
CALDERDALE AND
MID YORKSHIRE
BURTON
NEWCASTLE UPON
SHEFFIELD
UNIVERSITY
LEEDS TEACHING
ROYAL SURREY
NORTH WEST
BARTS AND THE
HEATHERWOOD
YEOVIL DISTRICT
LEWISHAM
BASINGSTOKE AND
DUDLEY GROUP OF
WHIPPS CROSS
KING'S COLLEGE
GREAT WESTERN
WEST SUFFOLK
SOUTHEND
IPSWICH HOSPITAL
ICT Use Score
20
ICT use: How Trusts Perform
18
16
14
3rd Quartile
12
Median
10
1st Quartile
8
6
4
2
Top performers in ICT use
TOP 10 TRUSTS
IT SCORE
MID CHESHIRE HOSPITALS NHS TRUST
18
LUTON AND DUNSTABLE HOSPITAL NHS TRUST
18
ESSEX RIVERS HEALTHCARE NHS TRUST / SINCE 2008
COLCHESTER HOSPITAL NHS TRUST
18
HARROGATE HEALTH CARE NHS TRUST
17
MEDWAY NHS TRUST
17
BARNSLEY DISTRICT GENERAL HOSPITAL NHS TRUST
16
AINTREE HOSPITALS NHS TRUST
16
OXFORD RADCLIFFE HOSPITAL NHS TRUST
16
EAST KENT HOSPITALS NHS TRUST
16
MAIDSTONE AND TUNBRIDGE WELLS NHS TRUST
15
Maximum possible score = 22
Low performers in ICT use
BOTTOM 10 TRUSTS
IT SCORE
FRIMLEY PARK HOSPITAL NHS TRUST
5
ROYAL MARSDEN NHS TRUST
5
CITY HOSPITALS SUNDERLAND NHS TRUST
5
PETERBOROUGH HOSPITALS NHS TRUST
5
SOUTHEND HOSPITAL NHS TRUST
4
ROYAL WOLVERHAMPTON HOSPITALS NHS TRUST
4
HILLINGDON HOSPITAL NHS TRUST
4
KINGSTON HOSPITAL NHS TRUST
4
ALDERHEY CHILDREN’S NHS FOUNDATION TRUST
4
IPSWICH HOSPITAL NHS TRUST
3
Maximum possible score = 22
Implications
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Management and ICT practices can be measured
and are not the same phenomena (correlation
coefficient = 0.17)
These measures suggest which trusts are more or
less likely to innovate in service delivery beyond
medical care areas
Many trusts still have a long way to go in
managing the service delivery aspects of their
work
We are analysing the determinants of trust
productivity, and preliminary results suggest a
definite IT/management interaction effect
Thank you
Assessment
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Our Management and ICT measures provide nonreactive objective measures
They are robust in measuring different
phenomena (correlation coefficient = 0.17)
They provide insights as to which trusts are more
likely to innovate
Potential application in research designs analysing
the determinants of productivity
Our alternative approach: web-census
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Developed an index measure of ICT use and
Management practices based on objective-non
reactive measures
Used Trusts’ websites to record the absence or
presence of key indicators that form part of the
index
Aggregated results in single indexes
We systematically reviewed the sites of 166 Acute
Health Care Trusts in England and populated the
indexes