Clinicians in Management: Does it Make a Difference?
Centre for Innovation in Health Management, 31 May 2012
Academics at the Centre for Innovation in Health Management within Leeds University Business School have attempted to examine the impact of clinical leadership on acute trust performance in this new paper. They utilised data from Annual Health Checks, national patient surveys and hospital standardised mortality ratios (HSMRs) over the period from 2005/06 to 2008/09 in their assessment. It is noted that, while there has been a small increase, the proportion of both clinicians overall (26 per cent) and doctors (14 per cent) on hospital boards remains internationally low.
Key findings from the research by Gianluca Veronesi and colleagues include:
- In 2008/09, 22 per cent of the 102 acute trusts for which full board membership information was available had chief executives with a clinical background. Such appointments were found to have 'positive consequences for the overall proportion of board members who are nurses and doctors.'
- The analysis of Annual Health Check data illustrated that 'an increasing presence of clinicians on boards results in progressively superior quality ratings.' Trusts attaining the highest quality rating had an average of 27.14 per cent clinician board members, compared to 21.42 per cent for those trusts awarded the lowest rating. This 'statistically significant' finding was also borne out in evaluations of HSMR and patient survey data.
- The proportion of doctors as opposed to nurses and allied health professions was found to be most impactful to trust performance.
- Veronesi et al's analysis of the relationship regarding financial and efficiency outcomes was 'far more ambiguous.' Trusts with financial ratings of 3 had a slightly higher proportion of doctors on their boards than those with a rating of 4. Furthermore trusts with a rating of 2 were found to have the highest overall percentage of clinicians on their board, at 28.13 per cent.
The authors conclude their research suggests 'previous claims about the contribution of clinical leadership may have been understated.' However they advocate further study, particularly in the area of primary care, and identify two specific areas to help to increase the part played by doctors in strategic decision-making:
- Talent management and human resource planning – ensuring the appropriate foundations are in place around training, career development and incentives.
- Managing organisational cultures – enabling more productive working relationships between clinicians and managers, devolution of decision-making and more widespread innovation.