NHS Hospitals with Doctors on the board of directors have better outcomes

NHS Hospitals with Doctors on the board of directors have better outcomes

Amanda Goodall has shown that hospitals with doctors as chief executives have 25% better clinical outcomes (statistically significant) in US hospitals. This is seen in other areas where 'expert leaders' have better outcomes. Kirkpatrick and Veronesi have looked at the board composition and found that in general boards of directors having more clinicians have lower HSMRs. Very specifically they found that boards of directors with more doctors in them clearly have a lower HSMR, higher CQC rating (actually their predecessor the healthcare commission's ratings) and higher patient satisfaction.

This prompted me to look at the Keogh 14 NHS Trusts that have been identified by the Department of Health and others as having problems mainly as a result of higher SHMI. The findings are of course compatible with the published research. 

All the 14 Keogh Trusts put together have only 3 doctors in their boards apart from their medical directors. Since medical directors on boards are statutory they are a common factor in all boards anyway.  So if medical directors are excluded from the calculations then the 

Keogh 14 trusts have 3 doctors (excluding Medical Directors) out of  184 board directors 1.63% of the board are doctors excluding MDs

Compare that to the 14 hospital trusts  with the lowest SHMIs (as of 2011) who have 15 doctors (excluding medical directors) out of 195 board directors 7.69% of the board are doctors excluding MDs

If we looked at HSMR (as of 2011) and compared high 14 and low 14 HSMR hospital trusts (the 14 is simply a number to match Keogh - there is no real logic or magic on the use of the number 14 here) a similar picture emerges:

NHS Hospitals with highest 14 HSMRs - 5 doctors (excluding Medical Directors)amongst 189 board directors  2.64% of the board are doctors excluding MDs

NHS Hospitals with lowest 14 HSMRs - 16 doctors (excluding Medical Directors) amongst 191 board directors. 8.37% of the board are doctors excluding the MDs

Medical directors as already mentioned are a mandatory appointment. Any other doctors appointed to the board is a sign of the value and recognition  by the trust and the appointment committees either on the basis of what the trust thinks that doctors bring to the table or as a recognition of research findings that expert led organisations do better. It is very clear that more doctors on the board of directors is associated with better outcomes.

It may not be politically correct to say so but it simply makes sense to appoint more doctors to the board of directors. 

What is important is that increasing the number of doctors in the board in the high SHMI or high HSMR hospitals must not be done as a matter of ticking the box - that will be very disrespectful to the concept. It should come out of a recognition of the value that the medical profession brings to the system as borne out by the findings above. 

It is also possible that when we cynically manipulate the undeserving into boards or when all boards have a higher number of doctors there will still be a difference between low and high performing hospitals. That is a different and new issue to be dealt with as it emerges. However in the meanwhile if as a result of increasing doctors in the boards we get better results we should respectfully and gratefully accept that.

It makes sense to have doctors on boards - let us do it.

Additional information added on 25 May 2015 - The difference in doctors in the board of directors between the Keogh 14 trusts and low SHMI trusts mentioned above is statistically significant with a p value 0.0081 (significant at p < 0.05 ) using a chi-square test

©M HEMADRI

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Notes: 

The trust boards listed above were identified from their respective websites accessed on 21 September 2013

Amanda Goodall's article: http://www.amandagoodall.com/CESifo_DICE-Spring_2013_Goodall_FINAL.PDF

Kirkpatrick and Veronesi's article on Clinicians in Boards: http://www.cihm.leeds.ac.uk/new/wp-content/uploads/2012/05/Clinicians-and-Boards.pdf

2011 SHMI and HSMR lists: http://www.bbc.co.uk/news/health-15897345?sort2

2012 low 14 SHMI trusts list is quite similar to 2011. I used 2011 since it was easier to access.

There were 7 BME board directors in Keogh 14 trusts and 7 BME board directors in 14 lowest SHMI trusts  

Keogh 14 Trusts

Basildon and Thurrock

Blackpool

Buckinghamshire

Burton

Colchester

Dudley Group

East Lancashire

George Eliot

Medway

North Cumbria

NLG NHS

Sherwood Forest

Tameside

United Lincoln

14 Low SHMI Trusts (2011)

West Middlesex

North West London Hosp NHS FT

Sheffield

Ealing

James Paget

Chelsea & Westminster

Newham/Barts

Whittington

Cambridge

St Georges

Kingston

UCLH

Royal Free

Imperial

14 Highest HSMR trusts (2011)

Morecambe Bay

Isle of Wight

Hull & East Yorks

North Cumbria

George Eliot

Yeovil

Dartford & Gravesham

University Hosp of North Staffordshire

Northampton General Hospital

Dudley Group

NLG NHS

Shrewsbury and Telford

Medway

Sherwood Forest

14 lowest HSMR trusts (2011)

Chelsea & Westminster

Airedale

Kings College

Salford

Newham/Barts

Guys and St Thomas

Frimley Park

Whittington

Cambridge

St Georges

Kingston

UCLH

Royal Free

Imperial