Urology NHS webpages: A review of NHS Trusts in England

Urology NHS webpages: A review of NHS Trusts in England

British Journal of Medical and Surgical Urology (2011) 4, 182—186 COMMISSIONED REVIEW Urology NHS webpages: A review of NHS Trusts in England Mary G...

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British Journal of Medical and Surgical Urology (2011) 4, 182—186

COMMISSIONED REVIEW

Urology NHS webpages: A review of NHS Trusts in England Mary Garthwaite a,∗, Matthew Bultitude b a

Department of Urology, 2nd Floor Lincoln Wing, St James’s University Hospital, Beckett Street, Leeds LS9 7TF, UK b The Urology Centre, Guy’s and St. Thomas’ NHS Foundation Trust, London SE1 9RT, UK Received 8 March 2011; accepted 13 March 2011

KEYWORDS Urology; Internet; Information services; Marketing of health services

Abstract The internet is set to play an ever-increasing role in the delivery of healthcare information. Within a climate of mounting market forces, the use of NHS Trust websites in advertising specialist services and relaying patient information is often an under-utilised asset. In this review we look at the current state of NHS Trust urology webpages in England. © 2011 British Association of Urological Surgeons. Published by Elsevier Ltd. All rights reserved.

Contents Introduction ................................................................................................ Methods..................................................................................................... Results...................................................................................................... Discussion................................................................................................... Conclusion .................................................................................................. Conflicts of interest......................................................................................... References..................................................................................................

Introduction While the origins of the internet can be traced back to the 1960s, it was not until the 1990s that there ∗ Corresponding author. Tel.: +44 113 2066797; fax: +44 113 2064920. E-mail address: [email protected] (M. Garthwaite).

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was an explosion of internet service providers and internet connectivity. By the end of 2010 there were estimated to be 2 billion users of the internet worldwide. In the UK 77% of the population (38.3 million people) are internet users, with 30.1 million people accessing the internet everyday [1]. Consequently it is vital for most businesses to have a professional web presence. For example, 31

1875-9742/$ — see front matter © 2011 British Association of Urological Surgeons. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.bjmsu.2011.03.002

Urology NHS webpages: A review of NHS Trusts in England million adults bought or ordered goods and services online over a 12-month period [1]. It is clear that given this level of internet use, NHS Trusts need to accurately and professionally showcase their services as their internet site is a very public front of the hospital. We reviewed the websites from all acute NHS Trusts in England to sample what urology-specific information is available for both patients and healthcare professionals.

Methods The NHS Choices website was used to identify all acute Trusts within England [2]. Out of 166 acute Trusts, 145 provide urology services. During December 2010 individual NHS Trust websites were evaluated for ease of navigation, content and quality of the urology-specific information provided. Ease of navigation was determined by the minimum number of mouse ‘clicks’ required to travel from the Trust homepage to any identifiable urology-specific departmental pages. Navigation was accomplished by using both a ‘search’ function and through a ‘list of services’ as available. The search terms used were ‘urology’, ‘urology services’ and ‘urology department’. The number of urology-specific pages was documented, along with the use of images such as photographs and video. MDT pages or staff directory listings were discounted unless they were hyperlinked from urology pages. If urologyspecific pages were identified their content was rated on staff profiles, listing and explanation of services provided, contact and location details, accessible patient information leaflets and the availability of referral guidelines for General Practitioners. Any other significant factors, such as a ‘date of last update’, typographical accuracy, links to external information sites (including a link to the BAUS website), were also recorded.

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Table 1 Urology-specific webpages and ease of navigation. n Departmental webpage Urology-specific webpage Single page >1 page Accessible via ‘Services’ Overall In ≤3 clicks Accessible via ‘Search’ Overall In ≤3 clicks

Table 2

98 (68.6%) 95 56 39 93 82 88 87

Number of sites listing staff information. n

Consultants Names Profiles Pictures Contact details Specialist nurses Names Profiles Pictures Contact details Junior doctors listed Managers details

75 40 21 32 43 13 5 17 4 13

Table 3 Number of sites with departmental contact and location details. n General enquiries Phone Fax Email Address Online form Appointment enquiries Ward information Ward location Clinic information Clinic location

41 (41.8%) 40 12 5 11 2 22 31 16 52 37

Results Of the 145 NHS Trust websites reviewed, 47 (32.4%) provided no information at all regarding their urology services. Of the 98 with departmental webpages, 95 were urology-specific, 93 were accessible via a ‘services’ tab and 88 via a search function (Table 1). Of the 95 urology-specific sites, 39 (41%) comprised more than one page.

71 of the 98 sites listed the specialist services offered by the urology department, but only 17 of these gave any explanation of what those services entail. 75 (76.5%) listed consultants (40 with profiles; 32 with contact details), 43 (43.9%) listed specialist nurses, while few listed either junior staff or management (Table 2).

184 Table 4

M. Garthwaite, M. Bultitude Patient information. n

Own information on conditions Own information on procedures Downloadable patient information leaflets Directly from urology pages Via generic Trust page Links to BAUS Links to external patient information sites

12 12 37 24 13 8 23

41 sites provided general departmental contact details (Table 3). Ward and clinic information was available on 31 and 52 sites, respectively. Only 18 urology websites had any information on referral guidelines for General Practitioners. A number of urology-specific sites had their own information on conditions or procedures within the text of their pages (Table 4). 37 sites offered downloadable patient information leaflets, either directly from the urology pages or via a generic patient information page. Of the 23 sites with hyperlinks to external resources, only 8 had a link to the BAUS website. Overall, the use of images/video was generally poor. Six sites had identifiable errors and only nine specified a ‘date of last update’. Three offered feedback on the website itself while one offered patient experience feedback.

Discussion The publication of the NHS White Paper, ‘Equity and Excellence: Liberating the NHS’, means the prospect of increased competition within the NHS looms large [3]. It seems likely that departments and hospitals will have to compete directly with each other in an open market, with the serious risk that some departments may be forced to shut. It will be vital for departments to attract ‘business’ in this new NHS. With 77% of the UK population using the internet (and rising), the public profile of the hospital via its website will be increasingly important to patients offered choice as to where they wish to be treated. With the added potential of competition from private healthcare suppliers, it is likely that the private sector will take full advantage of the web as a marketing tool. What is ultimately achievable might best be seen in America where it is vital for big hospitals to attract ‘customers’ — look at the Cleveland Clinic website for example [4]. The results of our survey make worrying reading for the majority of urology departments. 47 (32.4%) departments in England do not have a Urology pro-

file on their hospital website. Why would patients looking for high quality urology healthcare choose these departments? Of the departments that do offer a urology-specific profile, 56 out of 95 (58.9%) offer only a single page and many of these comprise only a few cursory lines. We were initially concerned over the ease of access to urology pages via the Trust website homepage. However, the vast majority of urology pages were identifiable via a ‘list of services’ (93/98) or using a ‘search’ function (88/98). The ‘three click rule’ refers to a general internet rule that any piece of content should take no more than 3 clicks to access [5]. Most were accessible within this limit (82 and 87, respectively) and the other 12 sites were accessible within 4 clicks. One important area for any departmental website must be information on the staff that patients will encounter. While 75 out of 98 sites listed the consultant staff, it was a surprise that 23 did not. Other relevant information was even poorer, with only 40 showing consultant profiles, 21 offering a photograph and 32 contact details. Nurse specialists were the next most commonly listed staff group (43/98). Both these groups are relatively permanent and therefore this information should be easy to keep up-to-date. Only 4 sites listed junior medical staff, however, this may be understandable due to the frequent rotations that occur. In a business orientated NHS, it will be vital to list the services that the department offers. While 71 out of 98 did feature a list, we accepted any one service as evidence of this. Only 17 of these gave any information about these services. Equally, very few offered information on procedures (12) and common conditions (12), although we accept that there are multiple sources of such information available on the internet. 23 departments offered links to other organisations or patient information sites as a way of finding extra disease-specific information, but only 8 linked to the new BAUS website which does feature a specific patient information section [6]. It was difficult to objectively rate appearance or accuracy of the websites. We attempted to note use of images/video and a general impression of accuracy. Use of images was generally poor with only 13 offering at least one picture per page (which we defined as acceptable). Three departments had video on their website. It is vital that whatever information is available is accurate and while we cannot judge this, 6 pages had obvious errors and this figure is likely to be much higher. Noting a recent ‘date of last update’ would suggest that the webpages are maintained and act as a surrogate marker of accuracy. Only 9 sites specified a ‘date

Urology NHS webpages: A review of NHS Trusts in England of last update’, while one site automatically puts the current date as the date of last update! We felt that if we were a patient or a relative of a patient, we would use the website for information on wards, clinics and for departmental contact details. Surprisingly, only 31 gave any kind of ward information with only 16 giving the location. Clinic information was better with 52 offering information and 37 giving the location. Only 8 gave information on pre-assessment clinics. While this information should be available in any communication sent to the patient, it would seem sensible to offer it on a website as well. In terms of contact details, many offer a consultant secretary telephone number on the website. 41 sites gave details on how to make general enquires, mainly by telephone (40), although 2 have e-communication and offer an online form for this. For patients with appointments, only 22 gave relevant contact numbers, which we felt was poor. One of the key indicators that hospitals will be required to show as the government changes the focus from targets to outcomes is patient satisfaction questionnaires. While these may be conducted at the hospital in the ward or clinic setting, it would seem logical to offer these on the websites as well. Only one department offered such patient experience feedback from the departmental pages. We did not analyse whether such content was available elsewhere on the Trust webpages, although we felt that a link should at least be available from the relevant speciality page. Finally, we looked at information for health care professionals. With the majority of the NHS budget due to be put under the control of GP consortia, it will become increasingly important to ensure that information on our webpages is aimed directly at them and meets their requirements. Although only GPs can tell us what information they would wish to see displayed on a departmental website, we felt that details on how to refer a patient to the department was probably a minimum requirement. To our surprise, only 18 offered this information. So what can you do? This paper has outlined some of the key areas of information that we feel might be important, although this list is far from exhaustive. Our advice would be to initially contact your IT department to discuss the current content and what can be realistically achieved. They will do the web editing and design for you — they just need the content. Appoint someone in the department as a content editor who will take responsibility for the development of the site. The temptation may be to flood the webpages with information, although generally less information that is kept regularly up-to-date is better. The content editor

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should draw up a rough structure of the website and think about how patients would navigate between these pages. Remember the ‘three click rule’ as a general principal — do not have lots of pages off other pages as they will never be found. Try and keep everything at one or two levels below the home page. Finally, do look at other websites for ideas. So how good is your website? We felt we should not list our data by hospital, but these are some examples of the better departmental webpages that we visited (in alphabetical order): Barts and The London NHS Trust [7]. Cambridge University Hospitals NHS Foundation Trust [8].1 Guys and St. Thomas’ NHS Foundation Trust [9]. Oxford Radcliffe Hospitals NHS Trust [10].1 The Newcastle upon Tyne Hospitals NHS Foundation Trust [11].

Conclusion In summary, NHS Urology websites are generally of poor quality with little available information. The potential of these sites is huge and represents an opportunity to display a professional and organised corporate image, while enhancing patient care.

Conflicts of interest The authors declare that there are no conflicts of interest.

References [1] Internet Access. Statistical bulletin from the office for national statistics; 2010, http://www.statistics.gov.uk/ pdfdir/iahi0810.pdf. [2] NHS Choices website. http://www.nhs.uk/ servicedirectories/pages/acutetrustlisting.aspx. [3] Department of Health. NHS white paper. Equity and excellence: liberating the NHS; 2010, http://www.dh.gov.uk/en/Publicationsandstatistics/ Publications/PublicationsPolicyAndGuidance/DH 117353. [4] Cleveland Clinic Urology Webpage. http://my. clevelandclinic.org/urology/default.aspx. [5] Joshua Porter. Testing the three-click rule. http://www. uie.com/articles/three click rule/. [6] BAUS. http://www.baus.org.uk/.

1 Links to an externally run site. This information is included in the analysis.

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[7] Barts and the London NHS Trust. http://www. bartsandthelondon.nhs.uk/Urology/. [8] Cambridge University Hospitals NHS Foundation Trust. http://www.addenbrookes.org.uk/serv/clin/surg/urology/ urology1.html. [9] Guys and St. Thomas’ NHS Foundation Trust. http://www. guysandstthomas.nhs.uk/services/urology/urology.aspx.

[10] Oxford Radcliffe Hospitals NHS Trust. http://www. oxfordradcliffe.nhs.uk/forclinicians/referrals/renal/ urology/urology.aspx. [11] The Newcastle upon Tyne Hospitals NHS Foundation Trust. http://www.newcastle-hospitals.org.uk/services/ urology.aspx.

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