The role of medical directors in quality improvement


This study explores the role of the medical director in quality improvement. Previous research has found an association between high levels of clinician involvement in hospital boards and higher quality of care. Findings from a longitudinal analysis by Veronesi et al1 suggest that it is clinical involvement in boards that is contributing to performance and not the reverse (high-performing organisations recruiting more clinicians at senior levels). However, little is known about how clinicians on the board improve quality.

We will be building on the results from the iQUASER2 study (funded by the NIHR Collaboration in Applied Health Research and Care (CLAHRC) North Thames). This study found that, in organisations with a highly developed approach to quality improvement, medical directors, in particular, appeared to play an important role as ‘boundary spanners’, linking ‘the board and the ward,’ providing the board with meaningful analyses of data, and aligning external demands with internal priorities.

We will be looking at the following research questions;

  1. What forms of work do medical directors do, both within and outwith their organisation? What forms of interaction and connectivity are established with (a) other doctors, (b) other professionals, and (c) external stakeholders (e.g. patient groups, commissioners and representatives of regulators and the NHS hierarchy)?

  2. How do medical directors view their role and identity?

  3. How is the work of medical directors received by other actors and stakeholders? (e.g. the medical ‘rank and file’, community groups).

  4. To what extent are policy objectives accomplished? With what contingencies?


  1. Veronesi, G., Kirkpatrick, I., and Vallascas, F. Clinicians on the board: what difference does it make?.Social Science & Medicine77 (2013): 147-155.)
  2. Jones, L., Pomeroy, L., Robert, G., Burnett, S., Anderson, J. E., & Fulop, N. J. How do hospital boards govern for quality improvement? A mixed methods study of 15 organisations in England. BMJ Quality & Safety 2017. doi:10.1136/bmjqs-2016-006433

Principal Investogator: Professor Naomi Fulop

Start Date and duration: September 2017 – 15 months

Other project team members: Dr Lorelei Jones