The top-performing hospitals in the US are more likely to be headed by a physician than a non-physician. That is the major finding of a cross-sectional study1 by Amanda Goodall, PhD, which examined the association between the ranked quality of a hospital and whether the Chief Executive Officer (CEO) is a medical doctor. To be published in the influential journal Social Science & Medicine, this study identified the top-100 US hospitals in three specialties – Cancer, Digestive Disorders, and Heart and Heart Surgery – as determined by quality ranking used in the US News and World Report’s “Best Hospitals” 2009. The Index of Hospital Quality (IHQ) scores used incorporated three areas of healthcare performance: structure, process, and outcomes. Then, data on each hospital’s CEO were collected and the CEO was classified as ether a physician-leader (trained in medicine) or a non-physician manager. Nurses were categorized as non-physicians. For each of the three specialties, the mean hospital-quality scores were significantly higher for physician-headed hospitals than for non-physician-headed hospitals. Among “Honor Roll” hospitals, 16 out of 21 hospitals were led by physician CEOs. In this select group of hospitals, those that were run by physicians had a mean IHQ score of 18.38, compared with a mean score of 12.60 for non-physician-led hospitals. Three points:
There appears to be a trend toward hiring non-physicians to lead hospitals in the US and the United Kingdom. Other countries might also be following suit. Although this study does not prove that medical doctors make better leaders, it does provide some empirical evidence (the first of its kind to be published) to support the hypothesis. In Malaysia, most public hospitals are headed by medical doctors. Subject to a fair amount of criticism (by non-physician managers) recently, this long-standing practice seems to be vindicated by the findings of this study.
Medical doctors may be more effective leaders for a number of reasons: acting as role models, having a better understanding of clinical processes, balancing the focus on patient safety and clinical outcomes with the need to grow revenues and the bottom line, etc. Whatever the underlying mechanism(s), it seems sensible to place medically-trained personnel in leadership positions to improve patient care, and by extension, hospital performance.
One limitation of Goodall’s study is the potential for confounding, e.g. by the wealth of the hospitals. In other words, the hospitals with the deepest pockets and/or highest reputation have the greatest choice of candidates to lead their organizations and the financial ability to hire physician executives. Therefore, the relationship between physician leaders and top-performing hospitals may be a function of the wealth and/or prestige of the hospitals rather than the managerial abilities of the physicians.
- Goodall AH. Physician-leaders and hospital performance: is there an association? Soc Sci Med [Internet] 2011;73(4):535–9. Available from: http://dx.doi.org/10.1016/j.socscimed.2011.06.025