MARCO TEÓRICO
2.2. ANATOMÍA DEL APARATO REPRODUCTOR MASCULINO
Two sources of data were used on organisational performance. These were the self-assessments provided by the Trusts in their responses to the
questionnaire survey undertaken in phase one, and routinely available data on performance collected by the Healthcare Commission and Monitor. As part of the national survey undertaken in Phase I of this project each Trust was invited to complete a self-rating of how effective they felt
arrangements for clinical leadership were in their organisation with respect to Quality, Financial Management, Overall Trust Performance and Patient Experience. This was on a rating scale of 1-10 with 10 representing most effective. Therefore for each Case Study site four rating figures between 1- 10 for each of the areas listed above are an initial source of self-report data.
Table 31 presents these ratings for each site with the type of Trust sub- headed for ease of comparison.
Table 31.Trust Self- Report Ratings
Sites Quality Financial
Management Overall Performance Patient Experience Acute Sites A 10 10 10 10 B 10 10 8 8 C 7 2 6 6 D 7 6 10 10 E 8 8 8 8 Mental Health and Learning Disability G 8 8 9.5 9.5 I 7 7 9 9 H 7 2 5 8 Specialist F 10 10 10 10
© Queen’s Printer and Controller of HMSO 2013. This work was produced by Dickinson et al. under the terms of a commissioning contract issued by the Secretary of State for Health.
Project 08/1808/236 183
It is worth reiterating that the data in Table 31 is self-reported and
informed the choice of sites as case studies. On the whole the ratings are uniformly high with only 3 individual ratings out of a total of 36 falling below 6. Nearly all Trusts therefore self-report their arrangements for involving doctors in leadership roles working well and affecting most aspects of the Trust positively. Particular exceptions are to be found in Sites C and H where Financial Management, with ratings of 2, is an area clearly not seen to be well served by current arrangements. It may well be that this area of functioning has a pervasive effect as both these sites also rate Overall Trust performance as 6 and 5 respectively. In the wider
context of performance data the value of such self-ratings is to be seen in terms of how the ratings match with other sources of independent data. A senior researcher based at Kings Fund (location of Principal Investigator) was asked to determine what performance data might be accessible with respect to the nine sites. This was a challenging task with three of the sites being Mental Health Trusts and one a specialist Trust and therefore not necessarily subject to the standard data sets for NHS Acute Trusts. In addition some sites were Foundation Trusts while others were not.
The following seven data sources therefore apply variably across the full set of sites. The data obtained was:
1. Monitor Foundation Trusts Financial Assessment- 1 = highest risk to 5 (lowest risk )2010/11
2. CQC Annual Health Check- weak/ fair/ good/ excellent. 2008/09
3. Dr Foster hospital guide; Standardised Mortality Ratio (100=average), sites coded above average, average, below average.
4. 2011 NHS Inpatient Survey- worse than average, average and better than average. 2010
5. Inpatient and Outpatient NHS Surveys and A&E Survey. Consistency in performance across the three surveys on the basis of 6 domains
(Dignity and Respect, Provisions of Information on care, Cleanliness, Confidence in Staff, Consistency in Communication, Involvement in decisions about care)- above average, below average and mixed performance. 2011
6. Mental Health Survey for community services- worse than average, average, better than average. 2011
7. NHS Staff Survey- highest 20%, above average, average, below average, lowest 20%. 2011
© Queen’s Printer and Controller of HMSO 2013. This work was produced by Dickinson et al. under the terms of a commissioning contract issued by the Secretary of State for Health.
Project 08/1808/236 184
Although sound data it must be recognised that the information applies on a Trust wide basis only. The following table summarises the results by different types of Trust.
© Queen’s Printer and Controller of HMSO 2013. This work was produced by Dickinson et al. under the terms of a commissioning contract issued by the Secretary of State for Health.
Project 08/1808/236 185 Table 32.National Performance Data
Sites Financial Management Financial Risk Quality of Services SMR Overall Inpatient Experience Consistency of Performance Across Patient Surveys Overall Staff Engagement Job Satisfaction Acute
C Fair N/A Fair Below
Average
Average Mixed Lowest 20% Lowest 20%
E Excellent 3 Good Above
Average
Average Above Average Above Average Above Average
A Good 3 Good Below
Average
Average Mixed Above Average Highest 20%
D Good N/A Fair Above
Average
Average Mixed Above Average Highest 20%
B Good 3 Excellent Below
Average
Average Above Average Above Average Highest 20%
Mental Health and Learning Disability Overall Experience of Mental Health
G Excellent 3 Good N/A Average N/A Below Average Above
Average
I Excellent 4 Good N/A Better than
Average
N/A Above Average Highest 20%
H Good N/A Weak N/A Average N/A Below Average Lowest 20%
Specialist
© Queen’s Printer and Controller of HMSO 2013. This work was produced by Dickinson et al. under the terms of a commissioning contract issued by the Secretary of State for Health.
186
Project 08/1808/236
From this sample of Acute Trusts it would seem that financial aspects are reasonably well managed with site E being rated as Excellent, the others good, apart from Site C which is Fair. In terms of Financial Risk (applicable only to Foundation Trusts) all three sites are rated 3 which is average in a 1-5 scale. In terms of quality of services (HCC rating and SMR) Site C is rated only Fair on Quality of Services but ‘below average on SMR’- which is the better end for this scale. Sites E and A are both rated ‘Good’ on Quality of Services but one (Site E) is ‘Above Average on SMR’, whilst the other (Site A) is below. It is not clear how ‘Good’ Quality of Service relates to an “Above Average” SMR.
Irrespective of the minor variability in the measures discussed to date, all sites are rated as ‘Average’ on Overall Inpatient Experience. The
consistency of patient survey data across years may be a better measure and hence two sites (E and B) are Above Average. Both of these sites are Good and Excellent on Quality of Services, although one of them (E) is Above Average on SMR. It is interesting to note that the two sites (A and D) who self-rated 10 on Patient Experience achieve ‘Average’ or ‘Mixed’ in terms of independent data.
In terms of the staff measures, one site (C) is in the Lowest 20% for both Overall Staff Engagement and Job Satisfaction. It is rated ‘Fair’ on Quality of Services but Average for Overall Inpatient Experience. The four remaining Acute sites are all ‘Above Average’ on Overall Staff Engagement and three (A, B and D) are in the highest 20% for Job Satisfaction. However, as they have variable performance data on the previous measures discussed it is not easy to suggest how high scores here relate to other aspects of performance.
In summary there is one site (B) where there is a consistent and largely strong set of performance data- good financial management, excellent Quality of Services, Below Average on SMR, Above Average on survey data over time, Above Average on Staff Engagement and in the top 20% for Job Satisfaction.
6.9.1Specialist Trust (site F)
As a specialist care Trust much of the previous data set does not apply. In fact only four of the nine possible items can be obtained for Trusts of this type. The scores suggest a ‘Good’ rating on Financial Management, and ‘Fair’ on Quality of Services. On Overall Staff Engagement and Job
Satisfaction this site is rated as Average. It is virtually impossible to draw any conclusions from this data.
© Queen’s Printer and Controller of HMSO 2013. This work was produced by Dickinson et al. under the terms of a commissioning contract issued by the Secretary of State for Health.
187
Project 08/1808/236
6.9.2Mental Health and Learning Disability Sites
There are five data sources, one of which ‘Overall Experience of Mental Health and Community Services’ replaces the two inpatient experience and patient surveys. In terms of Financial Management these sites are rated- Excellent (sites G and I) and Good (H). The two Mental Health Trusts that are Foundation Trusts are also rated 3 (Site G) and 4 (Site I) respectively. So this appears to be quite a strong area of performance.
Two sites (G and I) are rated Good for Quality of Services, whilst one (H) is rated ‘Weak’. However, this site is rated as Average on the Overall
Experience of Mental Health and Community Services, along with another site (G) although this is rated Good for Quality of Services (G) The
remaining site (I) is rated ‘Above Average’ on Overall Experience of Mental Health and Community Services. In fact Site I seems to have the strongest overall profile of the Mental Health Trusts.
In terms of Overall Staff Engagement two sites (G and H) are rated ‘Below Average’ and one (Site I) Above Average. This last site is also in the Highest 20% for Job Satisfaction. Site G is Above Average on Job Satisfaction
despite the ‘Below Average’ score on Overall Staff Engagement. The final site H- Below Average on Overall Staff Engagement - is rated in the Lowest 20% on Job Satisfaction.
Overall, despite the more limited data there is a little more internal consistency here with one site (H) having quite a poor profile- weak on Quality of Services, Below Average on Overall Staff Engagement and Lowest 20% on Job Satisfaction. Site H is thought about average in terms of
Overall Experience of Mental Health and Community Services. In contrast site I has a strong profile- Excellent on Financial Management and 4 on Financial Risk, Good on Quality of Services, Above Average on Overall Experience of Mental Health and Community Services, Above Average on Overall Staff Engagement and Highest 20% for Job Satisfaction.