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Hospital performance and clinical leadership: New evidence from Iran

Goodall, A. H. ORCID: 0000-0002-9074-1157 & Kakemam, E. (2019). Hospital performance and clinical leadership: New evidence from Iran. BMJ Leader, doi: 10.1136/leader-2019-000160


Purpose: There is growing interest in the potential need for clinical involvement in leadership and managementof hospitals. Most studies of clinical leadership use US and European data. This paper contributes the first evidence for the country of Iran. It examines three different forms of hospital system: public, private and social security organisation, and these include teaching and non-teaching hospitals. This study adds to a small but growing literature that examines the possible value of ‘expert’ clinical leaders.

Method: This study uses data from 72 general hospitals in the city of Tehran. The data were collected for years 2015 and 2016. Data Envelopment Analysis (DEA) is used in this study to assess hospital performance. Hospitals’ chief operating officers are divided into two groups: clinicians (the majority of whom are physicians) and non-medically trained managers.

Findings: The average performance scores for hospitals with clinical managers and non-clinically trained managers areequal to 96.68±5.50 and 89.78±7.20 respectively (P <0.001). Performance is thus higher under clinical managers. Outcome differences are observed in each of the three types of ownership, and in teaching and non-teaching hospitals. The advantage in performance-score varies, when comparing the clinically led institutions and managerially led institutions, by between 5 and 10 points on a 0-100 scale. These differences remain after regression-equation adjustment for other influences.

Practical implications: Succession planning and targeted leadership development is made more efficient with greater awareness about the kinds of leaders and managers that enhance organizational performance.

Publication Type: Article
Additional Information: This article has been accepted for publication in BMJ Leader following peer review, and the Version of Record can be accessed online at
Subjects: H Social Sciences > HD Industries. Land use. Labor > HD28 Management. Industrial Management
R Medicine
Departments: Bayes Business School > Management
Text - Accepted Version
Available under License Creative Commons Attribution Non-commercial.

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