Non Doctor CMD/CEO And Hospital Performance - Health - Nairaland
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| Non Doctor CMD/CEO And Hospital Performance by Zeus777: 6:20am On Aug 03, 2014 |
Physician-leaders and hospital performance: Is there an association? Amanda Goodall, 21 July 2011 In the past, hospitals were routinely led by doctors. That has changed. In the UK and the US, most hospital chief executive officers (CEOs) are non-physician managers rather than physicians (Falcone and Satiani 2008). Of the 6,500 hospitals in the US, only 235 are led by physicians (Gunderman and Kanter 2009). It has been suggested that placing physicians in leadership positions can result in improved hospital performance and patient care (Horton 2008, Falcone and Satiani 2008, Darzi 2009, Candace and Giordana 2009, Stoller 2009, Dwyer 2010). The UK has recently established five academic health science centres. Their mission is to bring the practice of medicine closer to research – in the hope that innovative science can more quickly be translated into clinical procedures (Smith 2009). Physician leadership was also prioritised in the 2008 National Health Service (NHS) review (Darzi 2008, 2009). Some outstanding US medical facilities – for example the Cleveland and Mayo clinics – have explicitly introduced leadership training (e.g. Stoller et al. 2007), and management and leadership education is being incorporated into medical degrees. Despite the growing body of research into hospital performance (see Bloom et al. 2010 and Gaynor and Propper 2010 on this site), there are currently no empirical studies that assess the physician-leadership hypothesis that hospitals perform better when they are led by doctors. To establish a clear relationship between leadership and organizational outcomes is challenging. Unlike in medical trials, random assignment – in this case of chief executive officers to hospitals – cannot be used. My research provides an empirical inquiry (Goodall 2011). It looks at the leaders currently being hired by hospitals and examines whether CEOs in hospitals ranked higher typically physicians or non-medical managers. The wealthiest and most prestigious hospitals arguably have the widest choice of leadership candidates. If it can be shown that hospitals positioned higher in a widely-used media ranking are more likely to be led by medical experts rather than managers, this is one form of evidence that physician-leaders may make effective CEOs. Studying CEOs of top-ranked US hospitals The paper identifies the CEOs in the top ranked hospitals in America – determining whether those hospitals situated higher in the league-table are more likely to be headed by physician-leaders or professional managers.To do this, one particular quality ranking is used, namely, the league tables produced by US News and World Report’s “Best Hospitals” 2009. I construct a dataset on CEOs in the top-100 hospitals in the three specialties of cancer, digestive disorders, and heart and heart surgery. The US News and World Report ranking is designed to inform consumers about where to seek treatments for serious or complex medical problems. Media-generated league tables cannot be viewed as entirely reliable measures of quality; nonetheless, using rating systems as heuristic devices to assess healthcare providers has become common in the US (Schneider and Epstein 1998) and it has been shown to influence consumers’ behaviour (Pope 2009). I use this ranking because it is one of the most established. The data in my study cover the top-100 hospitals in the three specialist fields of cancer, digestive disorders, and heart and heart surgery. Each hospital CEO is then identified and classified into one of two categories – physician-leaders, who have been trained in medicine (MD), and leaders who are non-physician managers. Physician-led hospitals are higher-quality hospitals To establish whether hospitals higher in the rankings are more likely to be led by physicians, I use t-tests and regression equations. I do this for the top-100 hospitals in each of the three medical fields of cancer, heart and heart surgery and digestive disorders. In the field of cancer there are 51 physician-leaders among this set of 100 CEOs. Thirty-three are in the top-50 hospitals, and 18 lead hospitals in the lower 50 group. For the other two specialities, there are, respectively, 34 physician-leaders in the top-100 hospitals in digestive disorders, and 37 in heart and heart surgery. As can be seen in Figure 1, in each of the three cases, the average hospital quality score of hospitals where the chief executive officer is a physician is greater than the score of the hospitals where the CEO is a professional manager. Figure 1. Average hospital quality score of hospitals led by physician CEOs and manager CEOs in three specialty fields In the statistical analyses, the regression equations reveal that the presence of a physician-CEO is positively associated with an extra 8 to 9 hospital quality points (at the p<0.001 level) – in short, hospital quality scores are approximately 25% higher in physician-run hospitals than in the average hospital. To control for the size of hospital, in the field of cancer I included a variable for the number of beds. However, this size variable was insignificant and, importantly, it did not affect the importance of physician-leaders. Why are better hospitals more likely to be physician-led? This study’s results are cross-sectional associations and use one particular hospital-quality ranking. This means they have important limitations. The findings do not prove that doctors make more effective leaders than professional managers. Potentially, they may even reveal a form of the reverse – assortative matching – in that the top hospitals may be more likely to seek out MDs as leaders and vice versa. Arguably, however, the better hospitals will have a wider pool of CEO candidates from which to choose, because of the extra status and wealth that they attract. This makes the fact established in this study an interesting one. The results show that hospitals positioned highest in the ranking have made judgements that differ from those hospitals lower down. On average they have chosen to hire physician-leaders as CEOs. These findings are consistent with my earlier work on the role of “expert leaders” in other (non-medical) settings – for example, presidents of research universities (Goodall 2006 2009a,b) and NBA basketball coaches (Goodall et al. 2011). Cross-sectional analyses can only be suggestive of causality. Nevertheless, it is interesting to consider possible explanations. Experts may have the advantage that they have acquired a deep intuitive knowledge about the core business of their organisations and this may help with decision-making and institutional strategy. Falcone and Satiani (2008) suggest that a physician-leader who has spent years as a medical practitioner has acquired integrity that implies “walking the walk” (2008, p92) which, they argue, enhances a leader’s credibility. Physician-leaders who have greater credibility may act as role models for medical staff and their presence may help hospitals to attract talented medical personnel. However, such explanations are merely suggestive; the mechanisms are not properly understood. There has been much discussion in the US, and increasingly in the UK, about the relative merits of having physicians and non-physician managers in leadership positions. Yet no evidence has been published one way or the other. This work does not establish that physicians make more effective leaders when compared with professional managers; but it starts the empirical process. It finds – in each of three disciplinary fields – that hospitals positioned higher in the US News and World Report’s “Best Hospitals” ranking are led disproportionately by physicians. The next, and vital, step for researchers is to design longitudinal inquiries into the possibility that physician-leaders improve the performance of American hospitals References US News and World Report (2009) “America’s Best Hospitals” ,methodology and ranking, produced by Research Triangle Institute. Bloom, Nicholas, Rebecca Homkes, Rafaella Sadun, and John Van Reenen (2010), “Why good practices really matter in healthcare”, VoxEU.org, 17 December. Candace, I and RW Giordano (2009), “Doctors as leaders”, British Medical Journal, 338:b1555. Darzi, A (2008), High quality care for all: NHS next stage review final report,Department of Health, London. Darzi, A (2009), “A Time for revolutions — The role of physicians in health care reform”, New England Journal of Medicine, 361:e8. Dwyer, AJ (2010), “Medical managers in contemporary healthcare organisations: a consideration of the literature”, Australian Health Review, 34:514-522. Falcone, BE and B Satiani (2008), “Physician as hospital chief executive officer”, Vascular and Endovascular Surgery, 42:88-94. Gaynor, Marty and Carol Propper (2010), “Healthcare competition saves lives”, VoxEU.org, 23 August. Goodall, AH (2006), “Should research universities be led by top researchers, and are they?”, Journal of Documentation, 62:388-411. Goodall, AH (2009a), “Highly cited leaders and the performance of research universities”, Research Policy, 38:1079-1092. Goodall, AH (2009b), Socrates in the boardroom: Why research universities should be led by top scholars, Princeton University Press. Goodall, AH (2011) “Physician-leaders and hospital performance: Is there an association?”, Social Science and Medicine, forthcoming Goodall, AH, MK Lawrence, and AJ Oswald (2011), “Why do leaders matter? A study of expert knowledge in a superstar setting”, Journal of Economic Behaviour and Organization, 77:265-284. Gunderman, R, and SL Kanter (2009), “Educating physicians to lead hospitals”, Academic Medicine, 84:1348-1351. Horton, R (2008), “The Darzi vision: Quality, engagement, and professionalism”, The Lancet, 372:3-4. Pope, DG (2009), “Reacting to rankings: Evidence from ‘America's Best Hospitals’”” Journal of Health Economics, 28:1154-1165. Schneider, EC, and AM Epstein (1998), “Use of public performance reports”, Journal of the American Medical Association, 279:1638-1642. Smith, SK (2009), “The value of Academic Health Science Centres for UK medicine”, The Lancet, 373:1056-1058. Stoller, JK, E Berkowitz, and PL Bailin (2007), “Physician management and leadership education at the Cleveland Clinic Foundation: program impact and experience over 14 years”, Journal of Medical Practice Management, 22: 237-42. |
| Re: Non Doctor CMD/CEO And Hospital Performance by prettyprettywow: 7:00am On Aug 03, 2014 |
The findings do not prove that doctors make more effective leaders than professional managers. correlation does not mean causation. So many limitations. Atleast he admitted the numerous limitations in the study. and I wonder why the study has not been replicated. This type of study is better carried out using a longitudinal research approach rather than cross-sectional. 2 Likes |
| Re: Non Doctor CMD/CEO And Hospital Performance by prettyprettywow: 7:11am On Aug 03, 2014 |
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| Re: Non Doctor CMD/CEO And Hospital Performance by lomaxx: 8:56am On Aug 03, 2014 |
prettyprettywow: The findings do not prove that doctors make more effective leaders than professional managers. Even a embryo knows that correlation does not mean causation. Establishing a causation in this type of scenario is going to be almost impossible to difficult. What research design are you going to use to establish a causation between physician/non-physician and best hospital leadership outcomes? It doesn't even make sense to compare the two. The physician and non-physician are two different sets of people - subjecting them to the same experience to arrive at a probable outcome is very flawed. It's just like taking two sets of people - non-alcoholics and alcoholics- and subjecting them to a study to see if alcohol really causes stomach cancer. That a cross-sectional approach was adopted initially doesn't mean that a longitudinal approach won't be(in the future). A cross sectional study may be disadvantaged in establishing causation but has the single plus of giving a paralleled hint of what may likely be the outcome if a longitudinal approach is adopted. I still think adopting a longitudinal approach to establish best leadership outcomes between physicians and non-physicians is flawed- the best will be a correlation. Adopting a longitudinal approach will be best if 2 sets of physicians are compared. One with mere clinical experience and the other with clinical and further professional training in management. Say compare 2 CMDs- one with a mere Fellowship and the other with a Fellowship and an MBA/Management training. Lomaxx. 1 Like |
| Re: Non Doctor CMD/CEO And Hospital Performance by lomaxx: 8:56am On Aug 03, 2014 |
| Re: Non Doctor CMD/CEO And Hospital Performance by Zeus777: 9:02am On Aug 03, 2014 |
prettyprettywow: The findings do not prove that doctors make more effective leaders than professional managers.longitudinal or cross sectional or whatever . THE POINT IS THAT THE VERY PRESTIGEOUS HOSPITALS IN THE UK AND US ARE STILL VERY MUCH HEADED BY MEDICAL DOCTORS AS CMD/CEO. 1 Like |
| Re: Non Doctor CMD/CEO And Hospital Performance by Nobody: 9:24am On Aug 03, 2014 |
lomaxx: Interesting analysis....although the gold standard would be a meta-analysis of several studies comparing physician led hospitals with non-physician led hospitals. |
| Re: Non Doctor CMD/CEO And Hospital Performance by prettyprettywow: 1:35pm On Aug 03, 2014 |
That some hospitals are headed by Drs does not mean that it is their birth right. it means that the Drs who are in such positions have the extra requirement to lead the hospital coupled with their medical knowledge (MBA, MHA, and not just MBBS). The medical knowledge is just an added advantage. But here, Nigerian physicians do not want to acquire the relevant requirement before ascending such position. What we are saying is that MBBS is not=CEO. The researcher used the words "non-medical CEOs and professional CEOs". Get the right skills, and you can all line up for the post. If we have a medical worker with good managerial skills, experiences and relevant requirement, then he is welcomed to be CEO. And not a JJC in administration. That's my point. Nigerians gave the physicians enough time to prove themselves, but they failed. Leadership of the hospital has been in the hands of Nigerian Physicians for decades, and look where they led us (188th out of 190) and you are here quoting research carried out in the developed world Zeus777: longitudinal or cross sectional or whatever . THE POINT IS THAT THE VERY PRESTIGEOUS HOSPITALS IN THE UK AND US ARE STILL VERY MUCH HEADED BY MEDICAL DOCTORS AS CMD/CEO. |
| Re: Non Doctor CMD/CEO And Hospital Performance by prettyprettywow: 1:40pm On Aug 03, 2014 |
I'm not sure you know what you are talking about. Longitudinal studies will mean following the leadership of the hospitals for a very long time to know if the present state is as a result of the present administration or previous good administrators. Longitudinal study is the best way to prove causation after you must have controlled for several things. Yes, it's very much possible to compare physician and non-physician CEO after controlling for as many extraneous variables as possible if you must use cross-sectional research design. You can't jump into conclusion which the author understood, hence his statement that the findings does not prove that physicians are better than professional CEOs. I think why every Dom, Dick, and Harry is citing this particular study is because no one has bothered to replicate it. I am not here to critic the research (The journal wil have to pay me for that), but to point out what the author already pointed out lomaxx: |
| Re: Non Doctor CMD/CEO And Hospital Performance by lomaxx: 2:17pm On Aug 03, 2014 |
prettyprettywow: .Longitudinal study is the best way to prove causation after you must have controlled for several things. Longitudinal study proves causation - yes, but in a controlled study. Establishing best leadership outcomes between a physician and a non-physician is not a controlled study. What exactly are you controlling for? The long and short of this is that your longitudinal study, in as much as it is aimed to establish causation, is flawed in that respect. The research method employed does not exonerate a flawed premise on which the study is done. Assuming you were to do a controlled study to establish best hospital leadership outcomes between physicians and non-physicians, what variables would you control? I'm still learning. I never stop learning. Lomaxx. 3 Likes |
| Re: Non Doctor CMD/CEO And Hospital Performance by Zeus777: 3:13pm On Aug 03, 2014 |
@mrs/mr/nurse /physio/pharm pettyprettyprettywow take ur colleagues and relocate to the federal universities in collaboration with ur NASU members go and order the university governing councils to cease having vice chancellors who arent from the department of management and accounting!! |
| Re: Non Doctor CMD/CEO And Hospital Performance by Lagusta(m): 3:23pm On Aug 03, 2014 |
Hmmmm a doctor must be appointed as CMD of a teaching hospital IF AND ONLY IF he has met the basic requirements i.e MBA, MPA, and maybe an MPH... In fact, i believe onlyPUBLIC HEALTH PHYSICIANS should be CMD, or doctors with MBBS, then the MPH, MBA and of course, a Ph.D to crown it all... Whats the business of a gynecologist, pediatrician or even a surgeon being the CMD, they usually return stagnated and not up-to-date on recent medical breakthroughs... Well, thats my opinion tho |
| Re: Non Doctor CMD/CEO And Hospital Performance by Zeus777: 4:23pm On Aug 03, 2014 |
Lagusta: Hmmmmwhat's ur opinion on professor of pharmacy becoming a federal university vice chancellor  1 Like |
| Re: Non Doctor CMD/CEO And Hospital Performance by Zeus777: 4:33pm On Aug 03, 2014 |
Lagusta: Hmmmmfunny enuf @ lagusta u REALY did make a lot of sense with ur post above. It might interest u to know that most of these teaching hospitals CMDs are university professors.... Far beyond just having a PHD 1 Like |
| Re: Non Doctor CMD/CEO And Hospital Performance by Lagusta(m): 5:27pm On Aug 03, 2014 |
Zeus777: what's ur opinion on professor of pharmacy becoming a federal university vice chancellor vice chancellor Lolzzza professor of academic repute, with sound mamagerial qualifications can be appointed as VC, but a teaching hospital Habaa nah |
| Re: Non Doctor CMD/CEO And Hospital Performance by prettyprettywow: 6:43pm On Aug 03, 2014 |
The study is better done using a longitudinal study. The main point is that the research method used is flawed. I wonder why the OP posted the research since it didn't prove anything. lomaxx: |
| Re: Non Doctor CMD/CEO And Hospital Performance by allycat: 6:43pm On Aug 03, 2014 |
Actually Bauchi state University and Ajayi Crowther University already have pharmacists as their vice chancellors |
| Re: Non Doctor CMD/CEO And Hospital Performance by drered(m): 6:54pm On Aug 03, 2014 |
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| Re: Non Doctor CMD/CEO And Hospital Performance by drered(m): 7:02pm On Aug 03, 2014 |
235 out of 6500 hospitals, a meagre 0.04% is led by physicians and you don't think its for a reason? Even the physicians that lead this hospitals have added qualifications and leadership skills or you think this qualities are by default inherent in doctors? In saner climes they apply what works.. And what works isn't making dr's CEO just cuz they are doctors cuz if that was it, it will be expressed in the number of hospitals led by MD's.. 2 Likes |
| Re: Non Doctor CMD/CEO And Hospital Performance by allycat: 7:15pm On Aug 03, 2014 |
I know these are not Federal Universities but in Federal Universities we have veterinary surgeons, zoologist, microbiologist as VC's . Any Proffesor who has the requisite background can become a vice chancellor because the main function of the university is to teach. The teaching hospital likewise is also an educational institution where medical doctors are trained and as such in Nigeria. So if a professional from within the system is to head such an institution I would think it right that someone involved in the core function of the institution should head it. In the Federal Universities the CMD is also a staff of the College of Medicine ie a Professor. This is so that such a person understands the dual functions of a teaching hospital I.e. Training and service. State teaching hospitals differ because of politics where teaching hospital CMD are political appointees that generally are answerable to the powers that be and that is why you have many state teaching hospitals having problems with accreditation. 2 Likes |
| Re: Non Doctor CMD/CEO And Hospital Performance by drered(m): 7:16pm On Aug 03, 2014 |
Zeus777: what's ur opinion on professor of pharmacy becoming a federal university vice chancellorSeriously? Lool. Pharmacists can do that too? |
| Re: Non Doctor CMD/CEO And Hospital Performance by ziga: 8:49pm On Aug 03, 2014 |
allycat: I know these are not Federal Universities but in Federal Universities we have veterinary surgeons, zoologist, microbiologist as VC's . Any Proffesor who has the requisite background can become a vice chancellor because the main function of the university is to teach. The teaching hospital likewise is also an educational institution where medical doctors are trained and as such in Nigeria. So if a professional from within the system is to head such an institution I would think it right that someone involved in the core function of the institution should head it. In the Federal Universities the CMD is also a staff of the College of Medicine ie a Professor. This is so that such a person understands the dual functions of a teaching hospital I.e. Training and service. State teaching hospitals differ because of politics where teaching hospital CMD are political appointees that generally are answerable to the powers that be and that is why you have many state teaching hospitals having problems with accreditation. |
| Re: Non Doctor CMD/CEO And Hospital Performance by Zeus777: 8:57pm On Aug 03, 2014 |
drered: 235 out of 6500 hospitals, a meagre 0.04% is led by physicians and you don't think its for a reason? Even the physicians that lead this hospitals have added qualifications and leadership skills or you think this qualities are by default inherent in doctors? In saner climes they apply what works.. And what works isn't making dr's CEO just cuz they are doctors cuz if that was it, it will be expressed in the number of hospitals led by MD's..so why is NHS reverting to dr only CEO ? Use ur Internet my friend1 Like |
| Re: Non Doctor CMD/CEO And Hospital Performance by ziga: 8:58pm On Aug 03, 2014 |
prettyprettywow: I'm not sure you know what you are talking about. Longitudinal studies will mean following the leadership of the hospitals for a very long time to know if the present state is as a result of the present administration or previous good administrators. Longitudinal study is the best way to prove causation after you must have controlled for several things. Yes, it's very much possible to compare physician and non-physician CEO after controlling for as many extraneous variables as possible if you must use cross-sectional research design. You can't jump into conclusion which the author understood, hence his statement that the findings does not prove that physicians are better than professional CEOs. It is funny how you choose to be rational whenever it suites you. I love how you analyzed the article to show that maybe you can't prove cause and effect from it. But please show me what studies you have done to show that non-medical CEOs are the solution to Nigeria's health problems. Please prove it to me after correcting for "extraneous variables" All this shout about CMD or no CMD is bourne out of bad belle. Let us work together to improve healthcare in Nigeria. Let us fulfill our individual responsibilities. Nobody should do more than he has been trained to do. And if you no fit, commot for road!!! 2 Likes |
| Re: Non Doctor CMD/CEO And Hospital Performance by Zeus777: 9:07pm On Aug 03, 2014 |
ziga:is the vice chancellor from pharmacy, medicine, engineering an administrator in qualification sense ? So to use ur skewed Physician CMD logic , those professors shouldn't be appointed VCs after all d VC post is administrative just like the CMD"s 1 Like |
| Re: Non Doctor CMD/CEO And Hospital Performance by ziga: 9:21pm On Aug 03, 2014 |
Zeus777: is the vice chancellor from pharmacy, medicine, engineering an administrator in qualification sense ? So to use ur skewed Physician CMD logic , those professors shouldn't be appointed VCs after all d VC post is administrative just like the CMD"s I think we might be saying the same thing. Management comes mostly with experience. Added qualifications however will be a bonus. So, just like the universities are not run by outside CEOs, hospitals shouldn't be run by outside CEOs. 1 Like |
| Re: Non Doctor CMD/CEO And Hospital Performance by drered(m): 9:48pm On Aug 03, 2014 |
ziga:What studies have been done in Nigeria to show that MD's are effective CEO's? What breakthroughs have been made with MD's as CEO's? What novel ideas have been born?.. Fulfil what individual responsibilities? At what point does your training intersect with heading hospitals? Talking bout training, pharmacy students take a whole course on management + the rigorous training they undergo so what bad belle are you talking about? If the cap fits you shouldn't wear it cuz traditionally MD's have been CEO's in Nigeira.? People can't be repressed for too long.. |
| Re: Non Doctor CMD/CEO And Hospital Performance by drered(m): 9:50pm On Aug 03, 2014 |
Zeus777: so why is NHS reverting to dr only CEOFurnish with links "my friend". |
| Re: Non Doctor CMD/CEO And Hospital Performance by ziga: 10:36pm On Aug 03, 2014 |
drered: What studies have been done in Nigeria to show that MD's are effective CEO's? What breakthroughs have been made with MD's as CEO's? What novel ideas have been born?.. Fulfil what individual responsibilities? At what point does your training intersect with heading hospitals? Talking bout training, pharmacy students take a whole course on management + the rigorous training they undergo so what bad belle are you talking about? If the cap fits you shouldn't wear it cuz traditionally MD's have been CEO's in Nigeira.? People can't be repressed for too long.. Please drop all these "We took this course in university" talk. Doctors are trained in management and public health as well. In fact, I don't know of any course that doesn't have some form of management integrated into it for that matter. It is basically a part of life. The healthcare needs of Nigeria has nothing to do with who is or who is not CEO. CEOs were introduced to make hospitals more profitable(for the owners) in developed countries. And this is being done to the detriment of the patient. A step towards profitability and accountability would be privatization. So, please lets stop with all the shouting. When and if Nigeria gets to the point where we have executives running hospitals, we will see how things go. But until then, the CMD is totally appropriate for running the hospital. 1 Like |
| Re: Non Doctor CMD/CEO And Hospital Performance by Zeus777: 10:36pm On Aug 03, 2014 |
drered: Furnish with links "my friend".dont be lazy |
| Re: Non Doctor CMD/CEO And Hospital Performance by ziga: 10:39pm On Aug 03, 2014 |
drered: [b] What studies have been done in Nigeria to show that MD's are effective CEO's?[/b]What breakthroughs have been made with MD's as CEO's? What novel ideas have been born?.. Fulfil what individual responsibilities? At what point does your training intersect with heading hospitals? Talking bout training, pharmacy students take a whole course on management + the rigorous training they undergo so what bad belle are you talking about? If the cap fits you shouldn't wear it cuz traditionally MD's have been CEO's in Nigeira.? People can't be repressed for too long.. What studies have been done to show that they are not effective CEOs despite all the inadequacies that Nigeria presents to them |
| Re: Non Doctor CMD/CEO And Hospital Performance by drered(m): 11:03pm On Aug 03, 2014 |
ziga:I won't drop something that is relevant to the point I'm making cuz the number of ignoramuses here are enormous hence the need for proper education. I really don't care much about who becomes CEO, matter of fact in the whole fracas between NMA and JOHESU the least of my concern is who gets to head hospitals. I'd just prefer it was any competent person with required qualification and experience .. But then when the competency of other professions are questioned in trying to prove a point then things have to be set straight.. 2 Likes |
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