"Does leadership matter?"

We spend a lot of time reading and talking about leadership.  Just conduct a random search on Google or Amazon using the key word "leadership" and you will get an idea of just how much time we spend on reading or talking about leadership.  The natural follow-up question is whether all this reading and talking about leadership makes any difference.  In order to answer that question, we first need to ask, "Does leadership matter?"  At least in regards to health care, the answer to this particular question appears to be "Yes!"

A group of investigators at the University of Surrey School of Economics (Shimaa Elkomy, Zahra Murad, and Veronica Veleanu) published the results of a study ("Does leadership matter for healthcare service quality?") involving the National Health Service in England in the International Public Management Journal.  They determined the overall quality of leadership in 152 hospitals during a 5-year period from 2010 to 2014 using a previously validated leadership framework.  The quality of clinical care at each hospital was assessed using staff-rated quality of care ("How likely are you to recommend treatment here?"), patient-rated quality of care (based upon patient/family experience data), and clinical quality (age-standardized hospital mortality rates within 30 days of emergency surgery).  

Using what I like to call "fancy statistics" (multiple regression analysis), they showed convincingly (at least in my mind - read the article and judge for yourself) that the quality of leadership significantly and positively affected staff-rated quality of care, patient-rated quality of care, and clinical quality!  In other words, leadership matters!

Health care is going through a critical time right now.  The challenge of the COVID-19 pandemic has certainly affected all of us, but it has hit the health care industry particularly hard.  The pandemic has also illustrated, quite effectively, that having the right leader in place makes all the difference.

There are also a number of studies suggesting that hospitals with clinically trained executives generally perform better than those who do not have leaders with a clinical background.  I've posted about these studies in the past (see "My shoes are brown and those are wings of gold on my chest!"), so I won't repeat myself here.  Elkomy, Murad, and Veleanu also do a good job of reviewing the literature that consistently shows superior performance (clinical as well as financial) when hospitals are led by executives with clinical backgrounds.

I believe, and most of the relevant studies would support, that leadership can be taught.  Given then that (1) leadership has a positive impact on clinical quality, (2) hospitals do better when clinicians are leading them, and (3) leadership can be taught, we should spend more time talking about how to build up the leadership skills in our clinical workforce.  We need strong leadership at all levels of the organization - to borrow a phrase from Elkomy, Murad, and Veleanu, "Boards to Wards" leadership.  As we emerge (and despite the recent trends, we are still doing better now than at the start of the pandemic) from COVID-19, we should look again at how much time and money we are investing for leadership development.  With all of the concerns about our health care system, it seems like it would be a great investment!