Does Better Leadership Equal Better Outcomes?

As a group that studies and teaches leadership to students and professionals in health care, we read the recent National Healthcare Leadership Survey with great interest. It si prepared by the National Center for Healthcare Leadership “to assess the adoption of evidence-based leadership development best practices by health care organizations.”

The Center rightly points out the importance of leadership as the health care system undergoes significant change in everything from treatment protocols to business models. There is much to be assimilated and communicated as organizations refocus their missions in this radically altered  — and still unsettled — landscape. Without effective leadership, many of the promising efforts to lower costs and improve quality “may have a lower probability of succeeding or meeting the public’s expectations,” according to the Center. We agree.

According to the study, health care organizations continue to lag behind the private sector in leadership development as measured by a benchmarking survey sent to large, non-health care corporations. Health care systems generally outperform freestanding hospitals and both for-profit and non-profit hospitals outperformed public hospitals.

It is admirable that the study examined whether or not a correlation could be found between evidence-based leadership development and the quality of patient outcomes. Sad to say, all that they could find was a “small, positive correlation” between leadership development and a composite quality process score.

The survey has significant limitations. First, the response rate was low: 12% for hospitals and 8% for health care systems. The benchmark survey had only six respondents. It is reasonable that there may also be some reporting bias as it would be reasonable to assume that those institutions with the greatest commitment to leadership development would be most likely to respond.

More important, the survey measures process but not content. For example, having a leadership competency model is measured but not the quality or robustness of that model. The same is true for a formal performance management system, succession planning, and other components measured. To assess the quality of each of the measures would greatly expand the scope of the research project and so this is meant not as a criticism but rather as a caution on how broadly to interpret its findings.

We believe that an effort to assess which leadership frameworks and models are most effective in health care settings would be a great place to start. One approach would be to reverse the Center’s process: start with those institutions that have exceptional patient outcome quality scores and test a hypothesis that there is a correlation to leadership quality. The second step would be to examine the approaches to leadership in those insitutions should a correlation be found.

Measuring leadership effectiveness is tricky business. It has vexed many in practice and academia. The stakes, however, are too great not to continue in relentless pursuit of an answer.

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