The role of top managers in the public sector: Evidence from the English NHS (November 2024)

Summary

Governments worldwide have sought to reform the delivery of public services by mimicking private sector governance models that grant top directors greater autonomy, give them responsibility for meeting key government targets and reward performance with respect to these targets. This paper examines a central plank of this approach–that directors can impact the organisations they run–in the context of English public hospitals, complex organisations with multi-million turnover. The authors find little evidence of top directors’ impact on hospital performance, though estimated differences in pay suggest that the directors are perceived to be differentiated by the market. The results question the effectiveness of blindly mimicking the private sector to bring about improvements in public sector performance.