Doctors make the best managers, US study concludes

Hospitals run by doctors outperform those run by managers, a study of 300 of the best hospitals in the United States has found (Social Science and Medicine 2011, doi:10.1016/j.socscimed.2011.06.025).

A qualified doctor was the chief executive in 51 of the top 100 cancer hospitals in the US, 34 of the best 100 hospitals for digestive disorders, and 37 of the top 100 cardiac hospitals.

Amanda Goodall, a senior research fellow at the Institute for the Study of Labour in Bonn, Germany, looked at the 100 hospitals that performed best in 2009 in each of three specialties—cancer, digestive disorders, and cardiovascular care and surgery—as ranked by the well established US News and World Report league tables, which look at hospitals’ performance in 16 specialties. She then ascertained whether the hospitals’ chief executive officers were doctors or professional managers.

Of the 21 hospitals ranked highest in the league tables’ “Honor Roll”—those that performed well in at least six of the 16 specialties—16 had chief executives who were doctors.

The study also found that the mean quality scores of the highest ranked hospitals were 30-40% higher in those led by doctors than in those led by professional managers in all the specialties investigated.

To check that the hospitals’ performance was not driving the result, the researchers removed the 52 hospitals that appeared in two or three of the three top 100 lists. Among the remaining 160 hospitals, those that performed best were disproportionately led by doctors.

Other research has shown that only 235 (3.6%) of the 6500 hospitals in the US have a medically trained chief executive. Finding out who runs hospitals in the United Kingdom is difficult, said Dr Goodall, but she believes that the results of this US study are just as applicable to the UK. “My instinct would be to say that in general medics playing a bigger role in the management of health service has got to be a good thing,” she told the BMJ.

Earlier this year the healthcare think tank the King’s Fund recommended that the NHS needs more clinical leadership and that leadership development should extend “from the board to the ward.” The government has since announced a new national leadership academy to give doctors and other clinical NHS staff more opportunity to develop their leadership skills (BMJ Careers 12 Jul, http://careers.bmj.com/careers/advice/view-article.html?id=20003742).

Dr Goodall said that the next step is to conduct longitudinal studies to see whether doctor managers improve hospitals’ performance. Assessing how doctors perform in managing health services, however, can be done only while ensuring that other factors remain the same—such as the money available.

She added, “Other important variables, such as a CEO’s [chief executive officer’s] tenure and the level and number of years of clinical experience that each CEO had obtained, could also be included.

“If it can be shown that physician leaders improve hospital performance, then the ensuing empirical question to be addressed is why and how this happens—by examining the transfer processes through which hospitals are influenced by their leaders’ actions.”