The Interplay Between CEO Experience and Hospital Performance Measurement in the South African Public Sector

Leadership capability is recognised globally as a critical determinant of hospital performance. However, little is known about how Chief Executive Officer (CEO) experience influences performance measurement utilisation in South African public hospitals, where systemic constraints limit managerial authority. This mixed-methods study explores the relationship between CEO tenure, professional background, and hospital performance across District, Regional/Tertiary, Academic and Specialised hospitals in the Tshwane Health District. Quantitative findings show a strong positive correlation between CEO tenure and Ideal Hospital Programme (IHP) scores in District and Specialised hospitals, but no meaningful correlation in Academic hospitals. Efficiency indicators such as Average Length of Stay (ALOS) were found to be structurally confounded by referral bottlenecks and therefore unsuitable for assessing leadership performance. Qualitative insights reveal systemic barriers, data credibility issues, and clinical hierarchies that limit CEOs’ ability to use performance measurement systems meaningfully. A context-sensitive model of leadership effectiveness is proposed, emphasising organisational context, system dynamics, and Boundary Spanning Capital as decisive mediators between leadership experience and measurable outcomes. The study provides empirical evidence for redesigning performance measurement frameworks and strengthening leadership capacity in South African public hospitals.