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Hospital performance and clinical leadership: new evidence from Iran
  1. Edris Kakemam1,
  2. Amanda H Goodall2
  1. 1 School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Republic of Iran
  2. 2 Cass Business School, City, University of London, London, UK
  1. Correspondence to Dr Amanda H Goodall, Cass Business School, City, University of London, London, UK; Amanda.Goodall.1{at}


Purpose There is growing interest in the potential need for clinical involvement in leadership and management of 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 is used to assess hospital performance. Hospitals’ chief operating officers are divided into two groups: clinicians, the majority of whom are physicians (doctors), and non-medically trained managers.

Findings The average performance scores for hospitals with clinical managers and non-clinically trained managers are equal 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 organisational performance.

  • clinical leadership
  • engagement
  • medical leadership

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  • Contributors Both authors have contributed equally to this paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

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