IDEAS home Printed from
   My bibliography  Save this paper

Does Leadership Matter for Healthcare Service Quality? Evidence from NHS England


  • Shimaa Elkomy

    (Surrey School of Economics)

  • Zahra Murad

    (Portsmouth Business School)

  • Veronica Veleanu

    (Surrey Business School)


In this paper 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, and for different metrics of quality of healthcare provision, including staff and patient satisfaction survey measures and clinical performance indicators. We find that task-oriented leadership has the strongest relationship with staff-rated hospital quality while change-oriented leadership relates most to 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 indicate that ideal healthcare leaders should behave as integrated leaders and that leadership matters at all levels of organizational hierarchy. This has important policy implications for continued support for the development and funding of integrated leadership programs in healthcare.

Suggested Citation

  • Shimaa Elkomy & Zahra Murad & Veronica Veleanu, 2018. "Does Leadership Matter for Healthcare Service Quality? Evidence from NHS England," Working Papers in Economics & Finance 2018-08, University of Portsmouth, Portsmouth Business School, Economics and Finance Subject Group.
  • Handle: RePEc:pbs:ecofin:2018-08

    Download full text from publisher

    File URL:
    File Function: Full text
    Download Restriction: no

    References listed on IDEAS

    1. Cooper, Zack & Gibbons, Stephen & Skellern, Matthew, 2018. "Does competition from private surgical centres improve public hospitals' performance? Evidence from the English National Health Service," Journal of Public Economics, Elsevier, vol. 166(C), pages 63-80.
    2. Christiane Bradler & Robert Dur & Susanne Neckermann & Arjan Non, 2016. "Employee Recognition and Performance: A Field Experiment," Management Science, INFORMS, vol. 62(11), pages 3085-3099, November.
    3. Nguyen Thi, Phi Linh & Briancon, S. & Empereur, F. & Guillemin, F., 2002. "Factors determining inpatient satisfaction with care," Social Science & Medicine, Elsevier, vol. 54(4), pages 493-504, February.
    4. Zack Cooper & Stephen Gibbons & Simon Jones & Alistair McGuire, 2011. "Does Hospital Competition Save Lives? Evidence From The English NHS Patient Choice Reforms," Economic Journal, Royal Economic Society, vol. 121(554), pages 228-260, August.
    5. Nicholas Bloom & Carol Propper & Stephan Seiler & John Van Reenen, 2015. "The Impact of Competition on Management Quality: Evidence from Public Hospitals," Review of Economic Studies, Oxford University Press, vol. 82(2), pages 457-489.
    6. Mannion, R. & Davies, H.T.O. & Jacobs, R. & Kasteridis, P. & Millar, R. & Freeman, T., 2017. "Do Hospital Boards matter for better, safer, patient care?," Social Science & Medicine, Elsevier, vol. 177(C), pages 278-287.
    7. Propper, Carol & Burgess, Simon & Green, Katherine, 2004. "Does competition between hospitals improve the quality of care?: Hospital death rates and the NHS internal market," Journal of Public Economics, Elsevier, vol. 88(7-8), pages 1247-1272, July.
    8. Ekvall, Göran & Arvonen, Jouko, 1991. "Change-centered leadership: An extension of the two-dimensional model," Scandinavian Journal of Management, Elsevier, vol. 7(1), pages 17-26.
    9. Pérotin, Virginie & Zamora, Bernarda & Reeves, Rachel & Bartlett, Will & Allen, Pauline, 2013. "Does hospital ownership affect patient experience? An investigation into public–private sector differences in England," Journal of Health Economics, Elsevier, vol. 32(3), pages 633-646.
    10. Veronesi, Gianluca & Kirkpatrick, Ian & Vallascas, Francesco, 2013. "Clinicians on the board: What difference does it make?," Social Science & Medicine, Elsevier, vol. 77(C), pages 147-155.
    11. Kessler, Daniel P. & McClellan, Mark B., 2002. "How liability law affects medical productivity," Journal of Health Economics, Elsevier, vol. 21(6), pages 931-955, November.
    12. Goodall, Amanda H., 2011. "Physician-leaders and hospital performance: Is there an association?," Social Science & Medicine, Elsevier, vol. 73(4), pages 535-539, August.
    13. Amy C. Edmondson, 2003. "Speaking Up in the Operating Room: How Team Leaders Promote Learning in Interdisciplinary Action Teams," Journal of Management Studies, Wiley Blackwell, vol. 40(6), pages 1419-1452, September.
    14. Leonard, Kenneth L., 2008. "Is patient satisfaction sensitive to changes in the quality of care? An exploitation of the Hawthorne effect," Journal of Health Economics, Elsevier, vol. 27(2), pages 444-459, March.
    15. Fraser Macfarlane & Joanne Duberley & Chris Fewtrell & Martin Powell, 2012. "Talent management for NHS managers: human resources or resourceful humans?," Public Money & Management, Taylor & Francis Journals, vol. 32(6), pages 445-452, November.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Kurt R. Brekke & Chiara Canta & Luigi Siciliani & Odd Rune Straume, 2018. "Hospital Competition in the National Health Service: Evidence from a Patient Choice Reform," NIPE Working Papers 19/2018, NIPE - Universidade do Minho.
    2. Moscelli, Giuseppe & Gravelle, Hugh & Siciliani, Luigi & Santos, Rita, 2018. "Heterogeneous effects of patient choice and hospital competition on mortality," Social Science & Medicine, Elsevier, vol. 216(C), pages 50-58.
    3. Eduardo Fe & Timothy Powell‐Jackson & Winnie Yip, 2017. "Doctor Competence and the Demand for Healthcare: Evidence from Rural China," Health Economics, John Wiley & Sons, Ltd., vol. 26(10), pages 1177-1190, October.
    4. Pan, Jay & Qin, Xuezheng & Li, Qian & Messina, Joseph P. & Delamater, Paul L., 2015. "Does hospital competition improve health care delivery in China?," China Economic Review, Elsevier, vol. 33(C), pages 179-199.
    5. Anne-Fleur Roos & Eddy van Doorslaer & Owen O'Donnell & Erik Schut & Marco Varkevisser, 2018. "Does price competition damage healthcare quality?," Tinbergen Institute Discussion Papers 18-040/V, Tinbergen Institute.
    6. Guccio, C. & Lisi, D. & Martorana, M.F. & Pignataro, G., 2020. "Incorporating quality in the efficiency assessment of hospitals using a generalized directional distance function approach," Health, Econometrics and Data Group (HEDG) Working Papers 20/17, HEDG, c/o Department of Economics, University of York.
    7. Piia Pekola & Ismo Linnosmaa & Hennamari Mikkola, 2017. "Competition and quality in a physiotherapy market with fixed prices," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 18(1), pages 97-117, January.
    8. Gobillon, Laurent & Milcent, Carine, 2017. "Competition and Hospital Quality: Evidence from a French Natural Experiment," IZA Discussion Papers 10476, Institute of Labor Economics (IZA).
    9. Cooper, Zack & Gibbons, Stephen & Skellern, Matthew, 2018. "Does competition from private surgical centres improve public hospitals' performance? Evidence from the English National Health Service," Journal of Public Economics, Elsevier, vol. 166(C), pages 63-80.
    10. Hugh Gravelle & Rita Santos & Luigi Siciliani & Rosalind Goudie, 2012. "Hospital Quality Competition Under Fixed Prices," Working Papers 080cherp, Centre for Health Economics, University of York.
    11. Giuseppe Moscelli & Hugh Gravelle & Luigi Siciliani, 2018. "Effects of Market Structure and Patient Choice on Hospital Quality for Planned Patients," School of Economics Discussion Papers 1118, School of Economics, University of Surrey.
    12. Martin Gaynor & Kate Ho & Robert J. Town, 2015. "The Industrial Organization of Health-Care Markets," Journal of Economic Literature, American Economic Association, vol. 53(2), pages 235-284, June.
    13. Kelly, Elaine & Stoye, George, 2020. "The impacts of private hospital entry on the public market for elective care in England," Journal of Health Economics, Elsevier, vol. 73(C).
    14. Kristian Niemietz, 2015. "Internal Markets, Management by Targets, and Quasi-Markets: An Analysis of Health Care Reforms in the English NHS," Economic Affairs, Wiley Blackwell, vol. 35(1), pages 93-108, February.
    15. Alfons Palangkaraya & Jongsay Yong, 2013. "Effects of competition on hospital quality: an examination using hospital administrative data," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(3), pages 415-429, June.
    16. Carol Propper, 2013. "Competition, Incentives and the English NHS," ifo DICE Report, ifo Institute - Leibniz Institute for Economic Research at the University of Munich, vol. 11(01), pages 16-20, April.
    17. Abe Dunn & Adam Hale Shapiro, 2018. "Physician Competition and the Provision of Care: Evidence from Heart Attacks," American Journal of Health Economics, MIT Press, vol. 4(2), pages 226-261, Spring.
    18. Francesco Longo & Luigi Siciliani & Hugh Gravelle & Rita Santos, 2017. "Do hospitals respond to rivals' quality and efficiency? A spatial panel econometric analysis," Health Economics, John Wiley & Sons, Ltd., vol. 26(S2), pages 38-62, September.
    19. De Regge, Melissa & Eeckloo, Kristof, 2020. "Balancing hospital governance: A systematic review of 15 years of empirical research," Social Science & Medicine, Elsevier, vol. 262(C).
    20. Roos, Anne-Fleur & O’Donnell, Owen & Schut, Frederik T. & Van Doorslaer, Eddy & Van Gestel, Raf & Varkevisser, Marco, 2020. "Does price deregulation in a competitive hospital market damage quality?," Journal of Health Economics, Elsevier, vol. 72(C).

    More about this item


    Healthcare Leadership; Integrated Leadership; Service Improvement; Public Service; England;
    All these keywords.

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • H57 - Public Economics - - National Government Expenditures and Related Policies - - - Procurement

    NEP fields

    This paper has been announced in the following NEP Reports:


    Access and download statistics


    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:pbs:ecofin:2018-08. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Shuonan Zhang). General contact details of provider: .

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.