An online survey of 27 London trusts reveals a dearth of website content addressing quality and an opportunity missed for providers. Robert Royce reports
Promoting competition between providers, empowering patients to make informed choices and increasing choice for patients of service provider are meant to be complementary forces for beneficial change.
The conventional wisdom is that providers wish to increase market share, that to do so they often need to make inroads into other providers’ market share (as opposed to creating demand where none previously existed), and that they need to compete on quality grounds.
‘If trusts are serious about differentiation and it is seen as important in gaining customers why isn’t more attention being paid to promoting it?’
But are providers making much effort to promote themselves to “customers” and if so how are they trying to differentiate themselves from their competitors? Here we examine how that is translated into what the average customer can readily see - namely NHS trust websites.
The content of the public websites of 27 trusts in London was examined for a period of approximately 15 minutes per trust. This was considered a proxy for what a reasonably well motivated consumer might do. The idea was to establish to what degree the trust in question was actively promoting the following:
- performance against particular quality indicators - for example, wait times, infection control, patient satisfaction, national awards, staffing ratios, patient reported outcome measures (PROMS) score, sub-specialty interests;
- explanations of quality issues in healthcare provision - for example, health indices such as hospital standard mortality rates, a PROMS score, how MRSA was measured;
- the degree to which the website was usable - for example how easy it was to find items, whether GPs had their own section.
While excluding mental health and community providers, the survey results for the NHS acute and specialist trusts provide an insight into the London market and the extent to which trusts have responded to the supposed incentives to gain extra income by attracting additional activity through differentiating themselves on quality grounds.
The answer is that those efforts - at least online - are singularly underwhelming. In some cases multimillion-pound organisations have websites that might be characterised as frankly amateurish with minimal content on healthcare quality. If these organisations want to attract additional customers they are doing a good job disguising their ultimate intentions (click on the image above right to see the full table).
Moving to specifics, the following results are noteworthy:
- only two trusts (both FTs) provided waiting times on their sites. No trust showed this information as part of its specialty/consultant profiles.
- one trust website had no search field;
- the websites for three trusts repeatedly crashed and for another its link on “reasons to choose” it did not work;
- the website for a recently merged trust did not work at all - access was attempted on three separate days. The results for that organisation have been taken from the website of one of its constituent trusts (which was still working), otherwise that organisation would have had a nil return;
- 19 trusts had information on sub-specialty interests by consultant, with eight trusts failing to provide this;
- 24 trusts had web pages targeted at GPs, while three trusts appeared to have nothing;
- 20 trusts carried eye catching patient testimonials and/or stories highlighting innovation or excellence;
- searches for PROMS brought a zero return for 15 trusts;
- search results for patient satisfaction brought a zero return from four trusts, with a range for the others from three to 1,517 results.
There was no discernible difference in the website content between FTs and non-FTs. Instead what was noteworthy was the lack of homogeneity. For example, one academic health science centre had detailed consultant profiles including their publications, while another did not even have sub-specialty interests shown - just a list of consultants for the specialty concerned.
No trust had a specific tab that linked to PROMS or patient satisfaction. Not one trust set out its PROMS score in relation to a specific service - for example, hip replacements. Moreover, trusts did not set out outcome measures, volumes, length of stay, or patient satisfaction results for any specific procedure, consultant or specialty, with the exception of some specialist areas such as paediatric cardiac surgery, infertility and, in one case, for hip replacements.
Trusts have their quality accounts on their websites mostly within the web pages relating to trust board publications. Some (but far from all) searches linked PROMS and/or patient satisfaction to the quality account but these documents are far too large and unwieldy to be of much use as a marketing tool.
If trusts are serious about differentiation and it is seen as important in gaining customers why isn’t more attention being paid to promoting that differentiation? Perhaps the answer simply is that in truth trusts do not believe that the promotion of a quality service is that important, or they do not believe it strongly enough to make an investment in this resource at the expense of something else.
Websites were generally uninformative in establishing how a trust compared with others on such matters as A&E access targets, 18 weeks, length of stay, mortality rates, complaints, readmissions and nurse and medical staffing ratios.
Perhaps it is explained by organisational nervousness about what the future might hold - do we want to say we are doing well if next month we do less well?
Perhaps trusts are not spending much time trying to differentiate themselves on their websites either because they do not think this is an effective medium or because they think influencing GPs remains much more important than members of the public. Or perhaps the answer lies more in the ambivalence with which extra activity can be regarded by both providers and commissioners.
All of the above conspires to undermine a key objective of the reforms - greater responsiveness to consumers with the aim of driving up quality and efficiency. It also raises a question about the commitment to another key element of government health reforms - the promotion of informed, empowered consumers.
Robert Royce is a visiting fellow at the King’s Fund.