1. The use of ICT and Management Practices and its contribution to productivity in Acute Healthcare Trusts Patrick Dunleavy Leandro Carrera Jane Tinkler

2. 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

3. 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

4. Organization represents itself online as doing Organization is actually doing A lotA little A lot1. Web census analysis correctly identifies situation 2. Façade activity Not much4. Organizations with ‘stealth’ activities 3. Web census analysis correctly identifies situation Organizations’ underlying pattern of activities can be mapped from their online presence

5. Tracking Management Practices  Included 41 indicators  Covering 7 key dimensions  Max possible score = 43 DIMENSIONINDICATORS 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

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

7. Tracking hospital trusts’ ICT use  Included 18 indicators  Covering 4 key dimensions  Max possible score = 22 DIMENSIONINDICATORS Online Information / Documentation 4 Good Practice on Website ICT Features 6 Web Usability4 IT Innovations4

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

9. Measuring Labour Productivity in NHS Trusts Outpatient Appointments Inpatient Spells Cost and Quality Medical Staff Headcount Input Output Productivity Adjusted for

10. 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)

11. 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

12. 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 > 1260%2% ≤ 126 > 94.525%13% ≤ 94.5 > 6350%61% ≤ 63 > 31.575%20% ≤ 31.5100%4%

13. 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 >4100%2% > 3 ≤ 475%84% > 2 ≤ 350%12% > 1 ≤ 225%2% ≤ 10%

14. 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 >0.85100%35% > 0.7 ≤ 0.8575%41% > 0.55 ≤ 0.750%15% > 0.4 ≤ 0.5525%6% ≤ 0.40%3%

15. NHS Trusts cost and quality adjusted output

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

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

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

19. Analysing the contribution of Management and ICT to Productivity OLS Estimates on Labour Productivity Independent Variable Cost Weighted Productivity Cost and Quality Weighted Productivity IT Use4.45 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 Training1.48 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 R2R2 0.210.23 N147

20. 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)

21. The effect of ICT on productivity conditional on Management Practices values

22. The effect of Management on productivity conditional on ICT values

23. 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

24. Thank you!