Does Leadership Matter for Healthcare Quality in England?

The effect of leaders is tremendous on organizational success.

Steve Jobs brought Apple from a garage startup to multi-billion dollar enterprise. Warren Buffet has made a reputation as one of the most important leaders of the modern world and gained a nickname of “Oracle of Omaha” building America’s fifth-most-valuable company BRKA with a value-based, hands-off style that incentivizes employees like owners.

Good leaders are known to bring good organizations, solve problems, invent, innovate and inspire. Zillions of studies have shown this over and over again in a number of different organizations, from small firms to big enterprises, from kindergartens to higher education institutions, from local councils to national governments. But we seem to know very little about whether leadership can affect healthcare outcomes.

Can good leadership be a solution for many problems that NHS is facing in the UK? While folk wisdom would suggest that “why not, if it works in private sector”. However, public healthcare sector is not a trivial environment to operate in. Healthcare staff are subjected a web of accountability which some would argue encourages overtly risk averse behaviour and discourages innovation. The adoption of aggressive target policy by the English NHS coupled with the publication of hospital outcome indicators, resulted in strong sanctions for poor performing managers. Yet we still don’t have a comprehensive evidence of whether the quality of the leaders in healthcare organizations have any bearings on such outcomes.

In a recent paper, we decided to take upon the responsibility of providing our attempt of a comprehensive longitudinal study of leadership effects on healthcare outcomes in NHS hospitals in England. We covered 5 year period from 2010-2015 and focused on the available data from all acute specialist and non-specialist hospitals in England. We looked at how staff rated low to high level managers in a hospital according to the four pre-defined effective leadership behaviours. Also instead of looking at just one measure of healthcare quality, we picked and chose three type of healthcare quality measures: staff rated hospital quality as a place to work, staff rated hospital quality as a place to receive treatment, patient satisfaction ratings, and an objective measure of hospital quality that has been used a lot in the scientific literature– mortality rates from non-elective surgeries.

What we found came not as a surprise. We found that overall good leadership positively predicts better healthcare outcomes in hospitals. When we looked at individual leadership styles and behaviours we found that change-oriented leadership - willingness to adapt and adopt new policies, act on feedback from patients and encourage staff to come up with new ideas, has the highest predictive power. This was followed by the task-oriented leadership behaviour, measured as managers’ dedication to clarifying job responsibilities and clearing up the channels of communication between managers and staff has the highest impact on staff’s satisfaction of a hospital as a place to work.

While our study presents empirical evidence of good leadership behaviours affecting healthcare outcomes, it is still not clear exactly through which routes the effect operates.? These are still open questions that need to be answered and we invite further research to delve into the specifics of the healthcare leader taxonomy and theories to advance the field further.

What do you think about the mechanisms operating behind the leadership – hospital outcome relationship? How does, for example, change-oriented leadership behaviour translate into lower mortality rates? We would be very happy to hear your views.

You can access the full text of the article here.

10/03/2018