KPMG’s experience from working with healthcare providers and payers in more than 40 countries is that a typical organization can become around 15 percent more efficient purely through operational, administrative and workforce improvements.¹ Scaled up to a global level, this suggests that the prize of better managed healthcare services may be in the order of one trillion dollars. For such a potential payback, it is a wonder that so little research has been done on the impact of different attempts to improve leadership and management on organizations’ quality, efficiency and outcomes. Investing in managers and leaders is a key part of achieving these improvements. Our systematic review identified four areas where returns are clearest:

1. Benefits to the wider workforce: These benefits include better teamwork and collaboration^{2 3 4}, increased clarity of communication to staff⁵, improved morale⁶ and an increase in ‘enabling others to act’⁷. For example, after the implementation of a leadership and management development program at several aged care sites in the US, staff reported an increase in transformational (as opposed to transactional) leadership behaviors, as well as a decrease in “passive avoidant” management styles.⁸
2. Improvements in patient experience and satisfaction: Several studies found improved patient satisfaction scores, with better scores for metrics such as “how well pain was controlled”, “nurses took time to listen,” and general satisfaction with services.^{9 10} Studies also found that various programs were associated with a reduction in patient complaints; improved communication between staff and patients; and improved continuity of care.^{2 5}
3. Direct benefits from developmental projects: Many management and leadership programs involve participants completing real-world improvement projects in their organization. These are often themed, such as action learning initiatives on patient safety, or innovation. Such projects can generate direct benefits to the employing organization, and help to target improvement efforts where they are most needed.¹¹ For example, the Management Academy for Public Health in the United States focused on training public health managers to generate entrepreneurial ideas within their organizations and involved an action learning project. Of 73 teams who took part in the program between 2000 and2002, 28 (38 percent) had projects that had generated revenue by 2007 (a total US$4 million across all projects).¹²
4. Increased confidence and use of management/leadership skills: A number of studies identified measurable improvements in good management and leadership behaviors, for example inspiring a shared vision and proactively facilitating others.⁴ Self-reported impact evaluations also consistently found improvements in the confidence of participants to cope with the demands of their roles.^{13 14 15}

No studies were found showing substantial, quantifiable benefits in terms of health outcomes, financial performance or staff turnover. However, this was more due to few or no studies asking these specific questions rather than a lack of effect. Most of the interventions measured were too small in scale to realistically affect cross organizational indicators on finance or quality.

What we do know is that when organizations are ‘well managed’ this can make a substantial difference to their performance: accounting for up to one third of profitability in all sectors¹⁶,and linked to better staff satisfaction and patient reported outcomes in health.¹⁷ Conversely, in depth investigations into large-scale failures in care routinely locate root causes in poor leadership, narrow management-by-objectives, disconnect between board-and bedside and a host of poor procedural, operational and administrative behaviors.¹⁸