Skip to main content Skip to main navigation menu Skip to site footer

Does a higher degree of education affect the performance of healthcare leaders? A systematic review

  • Awal Prasetyo ,
  • Jethro Budiman ,
  • Muzakar Isa ,


Introduction: Healthcare leaders must have management skills, administrative competency, and leadership roles to fulfill the market demands, patient satisfaction, health policy, and complexity of the healthcare environment. Healthcare leader is expected to improve the competency through educational and professional program attainment to maximize measurable performance outcome for the hospital. The study aimed to systematically review the existing literature and carefully examine the findings to investigate the relationship between higher education and the performance of healthcare leaders.

Methods: Three independent reviewers conducted a literature search in electronic databases for publications that met the inclusion and exclusion criteria. Each of the included studies' risk of bias was independently evaluated by the lead author, who then discussed their findings with the other two authors to reach a consensus. Five papers out of 529 found by database searching met the requirements for this study.

Results: The Majority of the study designs were cross-sectional (4 of 5). Most of the studies discussed the outcome of the higher degree of education in healthcare leaders.

Conclusion: Higher and advanced degrees of education affect the better leadership role, administrative competence, and patient experience. Top healthcare leaders mostly have higher degrees of education focused on healthcare.


  1. Vainieri M, Ferrè F, Giacomelli G, Nuti S. Explaining performance in health care: How and when top management competencies make the difference. Health Care Manage Rev. 2019;44(4):306–17. Available from:
  2. Chatterjee R, Suy R, Yen Y, Chhay L. Literature Review on Leadership in Healthcare Management. Journal of Social Science Studies. 2017;5(1):38. Available from:
  3. Ochonoma OG, Nwankwor CA, Henry-Arize I. Education and Hospital Manager’s Administrative Competency: What Impact is of a Higher Degree? IIARD. 2018;4(3):48–67. Available from:
  4. Berghout MA, Fabbricotti IN, Buljac-Samardžić M, Hilders CGJM. Medical leaders or masters?-A systematic review of medical leadership in hospital settings. PLoS One. 2017;12(9):e0184522–e0184522. Available from:
  5. Sfantou DF, Laliotis A, Patelarou AE, Sifaki-Pistolla D, Matalliotakis M, Patelarou E. Importance of Leadership Style towards Quality of Care Measures in Healthcare Settings: A Systematic Review. Healthcare (Basel). 2017;5(4):73. Available from:
  6. Ghanem M. Complementary education for healthcare personnel: a strategy to increase hospital performance. GMS Interdiscip Plast Reconstr Surg DGPW. 2014;3:Doc02. Available from:
  7. Sarto F, Veronesi G. Clinical leadership and hospital performance: assessing the evidence base. BMC Health Serv Res. 2016;16 Suppl 2(Suppl 2):169–169. Available from:
  8. Stefl ME. Common Competencies for All Healthcare Managers: The Healthcare Leadership Alliance Model. Journal of Healthcare Management. 2008;53(6):360–73. Available from:
  9. Calhoun JG, Davidson PL, Sinioris ME, Vincent ET, Griffith JR. Toward an Understanding of Competency Identification and Assessment in Health Care Management. Quality Management in Health Care. 2002;11(1):14–38. Available from:
  10. Ng TWH, Feldman DC. How Broadly Does Education Contribute to Job Performance? Personnel Psychology. 2009;62(1):89–134. Available from:
  11. Galstian C, Hearld L, O’Connor SJ, Borkowski N. The Relationship of Hospital CEO Characteristics to Patient Experience Scores. Journal of Healthcare Management. 2018;63(1):50–61. Available from:
  12. Kebede S, Mantopoulos J, Ramanadhan S, Cherlin E, Gebeyehu M, Lawson R, et al. Educating leaders in hospital management: A pre-post study in Ethiopian hospitals. Global Public Health. 2012;7(2):164–74. Available from:
  13. Baker SD, Mathis CJ, Stites-Doe S. An Exploratory Study Investigating Leader and Follower Characteristics at U.S. Healthcare Organizations. Journal of Managerial Issues. 2011;23(3):341–63. Available from:
  14. Besley T, Montalvo JG, Reynalâ€Querol M. Do Educated Leaders Matter? The Economic Journal. 2011;121(554):F205-227. Available from:
  15. Gede NT, Lawanson OA. Emloyees’ Characteristics and Job Performance of Staff of the Bayelsa State Ministry of Education in Nigeria. Mediterranean Journal of Social Sciences. 2011;2(4):33–40. Available from:
  16. Kebede S, Abebe Y, Wolde M, Bekele B, Mantopoulos J, Bradley EH. Educating leaders in hospital management: a new model in Sub-Saharan Africa. Int J Qual Health Care. 2009/12/01 ed. 2010;22(1):39–43. Available from:
  17. Aiken LH, Clarke SP, Cheung RB, Sloane DM, Silber JH. Educational levels of hospital nurses and surgical patient mortality. JAMA. 2003;290(12):1617–23. Available from:
  18. Carlos Pastor J, Mayo M. Transformational leadership among Spanish upper echelons. Leadership & Organization Development Journal. 2008;29(4):340–58. Available from:
  19. Aarons GA. Transformational and Transactional Leadership: Association With Attitudes Toward Evidence-Based Practice. Psychiatric Services. 2006;57(8):1162–9. Available from:
  20. Rappleye E. Where CEOs of 50 great health systems went to school [Internet]. Becker’s Hospital Review. Available from:
  21. Higgins J, Green S. Cochrane Handbook for Systematic Reviews of Interventions [Internet]. 5.2. London: The Cochrane Collaboration; 2017. 50 p. Available from:
  22. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009/07/21 ed. 2009;6(7):e1000097–e1000097. Available from:
  23. Clay-Williams R, Ludlow K, Testa L, Li Z, Braithwaite J. Medical leadership, a systematic narrative review: do hospitals and healthcare organisations perform better when led by doctors? BMJ Open. 2017;7(9):e014474–e014474. Available from:
  24. Hawker S, Payne S, Kerr C, Hardey M, Powell J. Appraising the Evidence: Reviewing Disparate Data Systematically. Qualitative Health Research. 2002;12(9):1284–99. Available from:
  25. Wells G, Shea B, O’Connell D, Peterson je, Welch V, Losos M, et al. The Newcastle–Ottawa Scale (NOS) for Assessing the Quality of Non-Randomized Studies in Meta-Analysis [Internet]. The Ottawa Hospital Research Institute; 2019. Available from:
  26. Herzog R, Ãlvarez-Pasquin MJ, Díaz C, Del Barrio JL, Estrada JM, Gil Ã. Are healthcare workers’ intentions to vaccinate related to their knowledge, beliefs and attitudes? A systematic review. BMC Public Health. 2013;13:154–154. Available from:
  27. Matthews E, Collins KS, Collins SK, McKinnies RC. Chief Executive Officers in US Hospitals. The Health Care Manager. 2013;32(1):69–76. Available from:
  28. Collins SK, Matthews EP, McKinnies RC, Collins KS, Jensen SC. Chief Executive Officers in US Hospitals. The Health Care Manager. 2009;28(2):134–41. Available from:
  29. Garman A, Goebel L, Gentry D, Butler P, Fine D. Healthcare Leadership “Outliersâ€: An Analysis of Senior Administrators from the Top U.S. Hospitals. Journal of Health Administration Education. 2010;27(2):87–97. Available from:
  30. Schray V. Assuring Quality in Higher Education: Recommendations for Improving Accreditation [Internet]. The Secretary of Education’s Commission on the Future of Higher Education; 2006 p. 1–8. (Fourteenth in a series of Issue Papers released at the request of Chairman Charles Miller to inform the work of the Commission). Available from:
  31. Khaliq AA, Walston SL. Predictors of Hospital CEO Affiliation with a Professional Association. Journal of Healthcare Management. 2012;57(5):358–73. Available from:
  32. Avolio BJ, Walumbwa FO, Weber TJ. Leadership: Current Theories, Research, and Future Directions. Annual Review of Psychology. 2009;60(1):421–49. Available from:
  33. Hetland H, Sandal GM, Johnsen TB. Burnout in the information technology sector: Does leadership matter? European Journal of Work and Organizational Psychology. 2007;16(1):58–75. Available from:
  34. Keller RT. Transformational leadership, initiating structure, and substitutes for leadership: A longitudinal study of research and development project team performance. Journal of Applied Psychology. 2006;91(1):202–10. Available from:
  35. Al-Sawai A. Leadership of healthcare professionals: where do we stand? Oman Med J. 2013;28(4):285–7. Available from:
  36. Collins DB, Holton EF. The effectiveness of managerial leadership development programs: A meta-analysis of studies from 1982 to 2001. Human Resource Development Quarterly. 2004;15(2):217–48. Available from:
  37. Kabene SM, Orchard C, Howard JM, Soriano MA, Leduc R. The importance of human resources management in health care: a global context. Hum Resour Health. 2006;4:20–20. Available from:
  38. World Health Organization. The world health report 2000 - Health systems: improving performance [Internet]. Geneva: World Health Organization; 2000 p. 206. Available from:
  39. Kasika BD. The effect of educational qualification on job performance: The case of Social Security Commission in Namibia (SSC) [Internet] [Thesis]. University of Namibia; 2015. Available from:
  40. Wolf J, Niederhauser V, Marshburn D, LaVela S. Defining Patient Experience. Patient Experience Journal. 2014;1(1):7–19. Available from:
  41. Kumah E, Osei-Kesse F, Anaba C. Understanding and Using Patient Experience Feedback to Improve Health Care Quality: Systematic Review and Framework Development. J Patient Cent Res Rev. 2017;4(1):24–31. Available from:
  42. Manary M, Staelin R, Kosel K, Schulman KA, Glickman SW. Organizational Characteristics and Patient Experiences With Hospital Care. American Journal of Medical Quality. 2014;30(5):432–40. Available from:
  43. LaVela SL, Gallan AS. Evaluation and measurement of patient experience. Patient Experience Journal. 2014;1(1):28–36. Available from:
  44. Ha JF, Longnecker N. Doctor-Patient Communication: A Review. Ochsner J. 2010;10(1):38–43. Available from:

How to Cite

Prasetyo, A., Budiman, J., & Isa, M. (2021). Does a higher degree of education affect the performance of healthcare leaders? A systematic review. Bali Medical Journal, 10(1), 174–180.




Search Panel