Doctors are the best hospital managers, study reveals

Would hospitals have fared better over the last 30 years if doctors were in charge? New research suggests they may have done


Almost 30 years ago, what was then the biggest change to the health service since 1948 was ushered in by a report that noted: "If Florence Nightingale were carrying her lamp through the corridors of the NHS today, she would almost certainly be searching for the people in charge."

That report, by Sir Roy Griffiths, led to the introduction of general management of hospitals in place of decision-making by consensus and organisation by administrators. It was not a template for getting rid of leadership by doctors – Griffiths said they should become more involved in running budgets – but in practice few were appointed to the new general manager posts. The men (and a few women) in suits took over.

There is today little challenge to the thrust of what Griffiths recommended. But the failure to engage doctors in management is lamented widely. And a new study raises the thought that hospitals might have fared better over the past three decades if more doctors had been encouraged to seek, and been selected for, chief executive roles.

The research has been carried out by Amanda Goodall, a visiting fellow at Cass Business School in London, who has found a clear correlation between high-performing hospitals and leadership by doctors. Her study is based on US hospitals, but she sees no reason why similar results would not be found in the UK. Surprisingly, she says it is the first analysis of its kind.

Goodall took the top 100 hospitals in each of three specialties – cancer, digestive disorders and cardiac care and surgery – as ranked by the respected US News and World Report league tables for 2009. She then researched the backgrounds of their chief executives. Of the top 100 cancer hospitals, 51 had chief executives who were qualified doctors; of the top 100 units for digestive disorders, 34 had medical chief executives; of the top 100 cardiac centres, it was 37.

The remarkable thing about these figures is that, according to other research, there are some 6,500 hospitals in the US and only 235 are led by doctors. So the high-performing doctor-leaders identified by Goodall come from a very small pool indeed.

Her study, to be published in the US journal Social Science and Medicine, further established that doctor-led hospitals had quality scores some 25% higher than other units. And when she stripped out of her analysis of the three lists of top 100-performing hospitals those that featured two or three times (52 in total) she found that the correlation still held strong for the remaining 160 units that featured only once.

Goodall, whose principal post is that of senior research fellow at the IZA Institute in Bonn, Germany, says: "It seems that age-old conventions about having doctors in charge – currently an idea that is out of favour around the world – may turn out to have been right all along."

Her next step is to examine the correlation over a longer timescale.

This notion that practitioners make the best leaders is becoming familiar territory for Goodall, whose previous work suggested that many of the best universities are headed by academics. It's something that Julian Le Grand, professor of social policy at the LSE and a former senior policy adviser to Tony Blair, instinctively goes along with.

"I was always rather impressed with the quality of the doctor-managers I met in the NHS," Le Grand says. "They have that great thing that they command the respect of their colleagues, which is a fundamental problem where chief executives come in from outside."

He adds: "I'm reasonably convinced by the evidence of [Goodall's] research. I think we should be moving as fast as possible to try to encourage doctor-management, as well as academic management of our universities."