The Royal Wolverhampton NHS Trust, which runs New Cross Hospital, has been ranked 105th out of 120 in England for its overall performance against key duties of care to its patients.
Sandwell and West Birmingham Hospitals NHS Trust ranks 86th, The Dudley Group NHS Foundation Trust 42nd and Walsall Healthcare NHS Trust 41st.
The rankings are based on four key metrics sourced from NHS data.
It takes into account patients waiting more than 18 weeks for hospital treatment, A&E patients waiting more than four hours to be seen, cancer patients waiting more than 31 days to start treatment and patients waiting more than six weeks for a test.
Health bosses in the region have acknowledged the pressures on services, but have stressed that progress is being made.
Diane Wake, elective care lead for the Black Country Integrated Care System, said: “We know that patients are waiting longer than we would like, and NHS staff are working extremely hard to address the backlogs. Despite exceptionally high demand for services, we are making significant progress, with almost 200,000 procedures being carried out every month across the Black Country.
"We have a particular focus on tackling the longest waiting times and are proud that ours was one of the first systems to eliminate 104-week waits.
“Considerable investment has been made in surgical hubs and diagnostic centres that will help to protect elective treatments from wider pressures, especially in future years.
"Increasing the use of technology such as robotic surgery and having dedicated day case units also helps to increase the amount of elective procedures that can be carried out, and allows patients to spend less time in hospital and recover in the comfort of their own homes."
There is a target for 96 per cent of patients to start any type of treatment for a new primary cancer within one month from the decision to treat.
But latest figures show the Wolverhampton trust achieved 70 per cent, Dudley 85 per cent and Sandwell 90 per cent, while the Walsall trust met the target with 99 per cent.
The operational standard for A&E waiting times is that 95 per cent of patients should be admitted, transferred or discharged within four hours of their arrival at an A&E department.
But the target is being missed by hospital trusts in the Black Country, with the latest average for England also standing at 69 per cent.
The latest figure for Walsall was 71 per cent, while it was 73 per cent at Sandwell, 77 per cent at Dudley and 80 per cent at Wolverhampton.
Patients should not be required to wait six weeks or longer for a diagnostic test, but latest figures show none of the Black Country hospital trusts met the target of 99 per cent.
The average for England was 70 per cent.
The NHS constitution sets a standard that 92 per cent of people waiting for elective treatment, for example, cataract surgery or a knee replacement, should also wait no longer than 18 weeks from their referral to their first treatment.
Across England the latest figure stood at 59 per cent, while at the Dudley trust it was 65 per cent, 60 per cent at Wolverhampton, 59 per cent at Walsall and 60 per cent at Sandwell.
The data has been combined for each trust by calculating how far they are from target, resulting in an 'average target divergence' figure.
Trusts with a higher average divergence from target are ranked lower than trusts with a lower average divergence from target.