Does leadership matter for healthcare service quality? Evidence from NHS England

Abstract

In this article, we provide first-hand evidence that leadership quality matters for the quality of healthcare provision, based on NHS England hospital trust data between 2010 and 2014. This is the first paper to study this relationship using individual leadership styles, namely, task-, relations-, change- and integrity-oriented as independent variables and four different metrics of quality of healthcare as dependent variables, including staff and patient satisfaction survey measures and clinical performance indicators. We find that task-oriented leadership has the strongest effect on staff-rated hospital quality while change-oriented leadership affects most patient satisfaction and the clinical measure. We also find some evidence that organizational autonomy and competition across hospitals moderates the effect of leadership quality on healthcare quality. Overall, our results have important policy implications for continued support for the development and funding of integrated leadership programs in healthcare.

Disclosure statement

There are no potential conflict of interest between the funding organization, the authors and the current research.

Notes

1 An NHS trust is an organisational unit within the English National Health Service, generally serving either a geographical area or a specialised function (such as an ambulance service). In any particular location there may be several trusts involved in the different aspects of healthcare for a resident. The trusts are not trusts in the legal sense but are in effect public sector corporations. Each trust is headed by a board consisting of executive and non-executive directors, and is chaired by a non-executive director.

2 Differently from Fernandez et al. (2010), we exclude diversity–oriented leadership because of the limited availability of the NHS Staff Survey data measuring diversity-oriented leadership behaviours in the years 2010–2015.

3 The King's Fund is an independent think tank in England, which is involved with work relating to the health system in England. It organises conferences and other events.

4 HSCIC is tasked with the responsibility for collecting, analysing and presenting health and social care data. All of our data is acquired in aggregated hospital trust level from this source.

5 We additionally use factor analysis to group patient satisfaction scores into two categories. For this alternative analysis of the patient satisfaction scores with factor analysis please see Appendix A of the paper.

6 Alternatively, we could have used factor or principal component analysis to reduce the questions per each grouping into one factor or component. However, doing so would result in losing some data for two questions defining change-oriented leadership role which did not exist in some years of the NHS Staff Survey (see Table 2). We have, however, conducted such analyses and the results are identical to the ones reported in this paper.

7 NHS Statistics, fact and figures. http://www.nhsconfed.org/resources/key-statistics-on-the-nhs (accessed 07/09/2017)

8 The results from pooled OLS, RE and hybrid model (Schunck 2013) panel regressions show similar results both qualitatively and quantitatively to the ones reported in the next section and are available upon request.

9 In a set of unreported regressions we also estimate pooled OLS and a hybrid model which produce quantitatively and qualitatively similar results to the ones reported in this section.

10 That is, 5.1% points more staff agreeing or strongly agreeing to a statement being true in NHS staff survey questions

Additional information

Funding

We thank the Leverhulme Trust for funding this research (grant number RL-2012-681).

Notes on contributors

Shimaa Elkomy

Dr Shimaa Elkomy ([email protected]) is a research fellow at the University of Surrey. Her research is interested in assessing the efficiency effects of policy shifts, skill promotion and technology development. She has a series of leading publications in public management and business and especially that relating to NHS England. Her paper “Cheap and Dirty: The effect of contracting out cleaning on cost and quality in English hospitals” is the most related to the current manuscript and complements this work.

Zahra Murad

Dr Zahra Murad ([email protected]) is currently a Senior Lecturer at the Department of Economics and Finance, University of Portsmouth. She has received her PhD from the School of Economics at the University of Nottingham. Her research interests are in biases in decision making, leadership and behavioral economics in general.

Veronica Veleanu

Dr Veronica Veleanu ([email protected]) joined the University of Surrey as an Assistant Professor (Lecturer) in Financial Economics. She completed her PhD in Applied Macroeconomics fully funded by the Economic and Social Research Council in 2013 also at the University of Nottingham. Her current research focus lies in the area of credit risk and macroeconomic activity, with wide interests in credit markets, macro-financial linkages, international economics, public sector and finance.