Purpose The aim of this systematic review was to identify key factors that contribute to organizational and individual resilience for healthcare workers and informal caregivers in elderly care and further, to examine how leaders can support these factors. Design/methodology/approach This study was conducted as a systematic integrative review with narrative synthesis. Searches were conducted in the following electronic databases: CINAHL via EBSCOhost Medline via EBSCOhost, Scopus and the British nurse index June, 2024, with updated searches in September 2025. Eligible studies were original, peer-reviewed empirical journal articles, published in English between 2014 and 2025. Findings A total of hundred and thirty-four studies were included in the review. The synthesis resulted in four themes (three deductive themes and one inductive theme) describing key factors supporting organizational and individual resilience for healthcare workers and informal caregivers, and how leaders support these factors: key factors for individual resilience in healthcare workers; key factors for individual resilience in informal caregivers; key factors for organizational resilience; and leaders as intermediaries for organizational and individual resilience. Originality/value The review findings underscore the interdependent relationship between individual and organizational resilience and highlight the importance of reconciling both aspects to create resilient elderly healthcare systems. Moreover, the review emphasizes the leader's role as a mediator between individual and organizational resilience and reinforces the leader's role in building resilient care systems, including supporting informal caregivers’ resilience. The findings also identify organizational factors that can enhance individual resilience and be translated into concrete measures for supporting individual resilience.
Purpose Health system governance significantly influences system performance and the achievement of sustainable health goals. However, there is still no consensus regarding its dimensions and measurement tools. The present study aimed to design and psychometrically evaluate a tool to assess health system governance. Design/methodology/approach This mixed-methods study was conducted in 2024. The initial version of the questionnaire was developed through a literature review, qualitative content analysis of interviews with 22 experts, and expert panel consultation. Content validity was assessed by 10 experts, and face validity was evaluated by 10 participants. Construct validity was determined through exploratory factor analysis (EFA) using SPSS 24, and confirmatory factor analysis (CFA) using AMOS 24, with responses from 273 individuals familiar with health system governance in Iran. Internal consistency was measured using Cronbach's alpha, and test-retest reliability was assessed on 25 individuals from the target group. Findings The initial questionnaire included 105 items, developed through a literature review and expert interviews. After content and face validity assessments, 15 items were removed. The final 90-item questionnaire was then subjected to construct validity testing. The KMO value was 0.925, and Bartlett's test was significant (p < 0.0009). Exploratory factor analysis (EFA) identified eight factors with positive eigenvalues, and all items showed factor loadings above 0.40 and were retained. Confirmatory factor analysis (CFA) indicated acceptable factor loadings across all dimensions, with P-values within acceptable ranges. Cronbach's alpha was 0.831, and external reliability was confirmed (ICC = 0.91, p < 0.001). Originality/value The developed questionnaire demonstrates acceptable validity and reliability and can be utilized to assess health system governance. The findings are expected to support policymaking, effective resource organization, intersectoral collaboration, and stakeholder engagement.
PurposeThe commercial determinants of health (CDoH) are the systems, practices and pathways through which commercial actors drive health and equity. This review aimed to identify CDoH governance approaches, distinguishing between promoted and criticized approaches. Design/methodology/approachWe conducted a systematic scoping review in PubMed and Google Scholar databases. Relevant grey literature was also identified through citation searching and reference list review. Our search strategy combined terms related to economic and commercial determinants of health, governance models and health outcomes. English-language publications between January 2000 to December 2025 were included. Relevant data from included sources were extracted and then synthesized using an inductive approach. FindingsOur review of 155 publications identified numerous CDoH governance tools and collaborative approaches, but it also revealed inadequate empirical evidence on governance strategies. Market regulation, taxation and civil society advocacy emerged as consistently supported governance mechanisms, while industry self-regulation was consistently identified as ineffective. Global frameworks and accountability mechanisms were highlighted as necessary elements for CDoH governance, but there was no convergence on specific accountability instruments. Collaborative governance approaches, such as health in all policies and whole-of-government, were generally viewed positively; however, private sector involvement remains contentious. Originality/valueTo our knowledge, this is the first review to systematically identify governance approaches discussed across the CDoH literature and examine patterns of support or criticism for different approaches. We found inadequate empirical evidence on the effectiveness of specific approaches and a lack of consistent terminology, which has important implications for future research.
Purpose This paper explores the role of governance officers in an NHS Trust. It examines how they negotiate the space between managers and clinicians to ensure accountability.Design/methodology/approach Using a phenomenological approach, semi-structured individual interviews were conducted with governance officers (n = 8) and a focus group (n = 5) to explore their lived experiences and views within an NHS Trust. The study draws on theoretical frameworks relating to Role Theory, Foucault's theory of power and Bourdieu's theory of practice. The data were analysed thematically using Braun and Clarke's (2006) method.Findings The key themes emerging from the data are: the governance officer role; pleasures and pains; power dynamics; unity despite diversity; the pursuit of accountability; policing and nurturing: approaches to accountability; self-perception and social position; forming bridges. Surveillance, a network of interactions and power dynamics influence how governance officers ensure accountability and this shapes their identity.Originality/value This is the first research study, to the author's knowledge, to explore, theorise and provide detailed insights into the role of governance officers. This pivotal role is important in ensuring accountability at the local level of the NHS and in providing high-quality patient treatment and care.
Purpose Despite progress towards Universal Health Coverage (UHC) in high-income countries, people experiencing socioeconomic disadvantages often struggle to access healthcare services not covered by public health insurance. This study explores the factors contributing to financial barriers to healthcare access (FBHA) among socioeconomically disadvantaged individuals in Edmonton, Canada.Design/methodology/approach Employing a convergent parallel mixed-method cross-sectional design, the study collected both quantitative and qualitative data through an interviewer-administered questionnaire. Logistic regression was used to examine associations between socioeconomic indicators and FBHA, while qualitative data were analyzed using inductive qualitative content analysis.Findings Among the 392 participants, 62.50% were women, 39.03% experienced housing instability, 49.49% reported health conditions, and 38.78% encountered FBHA for services not covered by public health insurance. Having additional health insurance (OR = 0.40, 95% CI: 0.24-0.65) and housing stability (OR = 0.46, 95% CI: 0.27-0.78) were associated with lower odds of FBHA; however, experiencing food insecurity was associated with greater odds (OR = 3.85, 95% CI: 1.66-8.93). Participants reported numerous health needs remaining unaddressed due to prohibitive costs, including dental and vision care, mental health services, prescription medications, and other essential services.Originality/value This study offers original contributions by focussing on individuals excluded from healthcare due to financial barriers, an often-overlooked group in healthcare access research, and by clarifying where such barriers may persist despite UHC. To substantiate this focus, the study integrates quantitative estimates with community-informed evidence and specifies how food insecurity, housing instability, and limited additional insurance converge to sustain unmet needs. The findings suggest that more inclusive policies and targeted interventions might be warranted.
Purpose Identifying the factors that affect migrants' access to healthcare services is critical not only for the sustainability of healthcare systems, but also for reducing health inequalities, preventing the spread of disease, and improving public health indicators. The aim of this study is to generate prioritized policy strategies to improve migrants' access to health services.Design/methodology/approach The factors affecting migrants' access to health services are weighted using the SF-DEMATEL method. In addition, a ranking analysis was conducted using the SF-TOPSIS method for G7 countries to identify good policy examples that should be followed. This prioritization approach serves as evidence-based guidance for public health policymakers.Findings The analysis results show that the most important criterion affecting the process is the lack of integration into the health system (w=0.146). The second most important factor is language and communication barriers (w = 0.145). The country with the best practice is the United Kingdom with a weight of 0.883.Research limitations/implications In the health sector, where resources are scarce, access to health services is important. The problems faced by migrants make it difficult for them to access health services. The main contribution of this study is to identify priority strategies with novel methods. Policymakers should place solutions to integration and language barriers at the center of public health strategies in order to ensure equal access to health services.Originality/value This is the first study to address the issues of immigrants and access to healthcare using the DEMATEL method integrated with spherical fuzzy numbers.
Purpose This study aims to investigate the impact of digital technologies on healthcare performance and the moderating role of governance in both developed and developing countries. Design/methodology/approach The analysis covers data from 2013 to 2020 and employs the generalized method of moments estimation technique. Findings Empirically, the study confirms that digital technology enhances healthcare performance in developed countries, while it diminishes performance in developing countries. In response to the declining healthcare performance in developing countries, the study extends the analysis by incorporating an interaction term between digital technology and governance. The results provide evidence that governance plays a significant moderate role in the relationship between digital technology and healthcare performance. In developed countries, governance further enhances healthcare performance, while in developing countries, it helps transform the negative impact of digital technologies into a positive one. Research limitations/implications As a result, the adoption of digital technologies must be accompanied by effective and efficient governance to strengthen healthcare performance in both developed and developing countries. Originality/value While the benefits and challenges of digital technologies in healthcare have been widely explored, empirical studies that examine the moderating influence of governance in this context remain unexplored.
Purpose-This conceptual paper explores the moral and institutional foundations of healthcare quality, arguing that excellence should be understood not as a managerial outcome but as a teleological and ethical aim of care. It reframes governance as the institutional form of practical reason and leadership as the prudential virtue that operationalises ethical deliberation within healthcare organisations. Design/methodology/approach-Through a philosophical analysis grounded in Aristotelian virtue ethics and contemporary organisational theory, the paper develops a conceptual synthesis connecting excellence, governance and leadership as interdependent dimensions of moral rationality in healthcare. It draws on Donabedian's humanistic view of quality, Habermas' theory of communicative action, and recent frameworks of stewardship and organisational learning. Findings-Quality is not a technical property but a moral practice embedded in institutional structures. Governance provides the deliberative framework that aligns ethical purpose with collective action, while prudential leadership embodies the moral agency that sustains this alignment. Integrating virtue ethics into governance theory rehumanises quality improvement and repositions measurement as reflective learning. Research limitations/implications-As a conceptual paper, this study does not include empirical validation. Its contribution lies in developing a normative and theoretical framework linking ethics, governance and leadership as interdependent dimensions of healthcare quality. Future research should explore how prudential judgement and ethical deliberation are institutionalised in governance and leadership practices through qualitative and mixed-method studies. Empirical testing of the proposed triadic model could strengthen understanding of how moral purpose, institutional reasoning and virtue interact in real organisational settings to sustain quality and humanistic improvement. Practical implications-The triadic framework of excellence, governance and prudential leadership offers healthcare organisations a practical lens to align ethical purpose with management and quality systems. Boards can use it to design deliberative structures-such as reflective dashboards, ethical quality councils and patient-inclusive reviews-that integrate moral reasoning into performance oversight. Executives and quality teams can adopt the model to foster stewardship, dialogue and learning rather than compliance. Leadership development programmes may incorporate prudential reasoning and narrative reflection to cultivate moral agency, supporting governance processes that sustain human-centred, ethically coherent quality improvement. Social implications-By reframing quality as a moral practice rather than a technical process, this framework promotes a culture of ethical responsibility and human flourishing in healthcare. It highlights the social value of governance that protects dignity, transparency and trust within institutions. Embedding prudential leadership encourages moral deliberation and shared learning, strengthening the social legitimacy of healthcare organisations. The model supports systems that balance efficiency with compassion, ensuring that improvement initiatives respect professional integrity and patient humanity, ultimately enhancing the ethical and social sustainability of healthcare systems. Originality/value-The paper proposes a normative and conceptual model linking ethics, governance and leadership as the practical reason of healthcare quality. It offers theoretical grounding for empirical research on ethical governance, professional responsibility and institutional excellence, and actionable implications for boards, managers and quality teams.
PurposeIn the Philippines, Republic Act 10754 (RA 10754 or An Act Expanding the Benefits and Privileges of Persons with Disability) was enacted to give persons with disabilities more economic opportunities through the provision of discounts and privileges. However, it is unclear what issues have been encountered in implementing this policy. This study aims to identify implementation issues of RA 10754 in the country.Design/methodology/approachFrom August to November 2023, we conducted 22 interviews with persons with disabilities, social workers in select local government units in the Philippines responsible for the issuance of the persons with disabilities ID (PWD ID), representatives of business establishments where disability benefits can be accessed, and healthcare workers responsible for the initial assessment of the person with disability. The proceedings from these interviews were transcribed, and these transcripts were analyzed thematically.FindingsImplementation issues identified include a lack of awareness among persons with disabilities, healthcare workers and business establishments, difficulty in securing medical certificate, fixers and bureaucratic intermediaries, issues related to benefits and claims, including problems with accessing disability benefits, differences in honoring PWD IDs, abuse of disability benefits and discrimination. Stakeholders suggested improving awareness, clearer classification, extent of disabilities and duration of benefits covered by the PWD ID and deterrents for abuse.Originality/valueThis paper describes one of the first studies conducted to describe the implementation issues of a disability policy in a lower middle-income country from the perspective of multiple stakeholders. The results of this study will hopefully guide policymakers globally to improve the implementation of disability policies to make it more equitable to all stakeholders involved.
PurposeThis study examines systematically the trends, patterns and determinants of medical emigration from Peru, providing insights into the factors influencing physician mobility in a middle-income context. Design/methodology/approachWe conducted a longitudinal descriptive analysis of 68,073 Peruvian physicians spanning the years 1994–2021. The dataset incorporated sociodemographic attributes and migration-related variables, with factors associated with emigration evaluated using a Cox proportional hazards regression model. FindingsMedical emigration increased steadily across the study period. The hazard of emigration among physicians was associated with demographic factors, with higher hazards observed among those originally from Lima, Peru (HR = 2.43, 95% CI 2.29–2.58, p < 0.001), those graduating from a private university (HR = 1.77, 95% CI 1.66–1.88, p < 0.001), and those obtaining a degree from a foreign institution (HR = 1.59, 95% CI 1.44–1.75, p < 0.001). Increasing age was associated with a lower hazard of emigration, with each additional year reducing the hazard by 10% (HR = 0.90, 95% CI 0.89–0.90, p < 0.001). Research limitations/implicationsThe study shows that health professional migration in Peru is driven by both internal and external factors. A limitation is the limited evidence on return migration and its psychosocial impact on returnees. Future research should explore how working conditions, burnout and mental health influence migration decisions. Incorporating the mental health component into the analysis will allow for the design of more comprehensive and sustainable repatriation policies that respond to the real needs of migrant professionals and their families. Practical implicationsClosing the health workforce gap requires strategic planning, specialized training and improved working conditions. Repatriation strategies should include not only material incentives but also mental health support to mitigate the effects of burnout, adaptation and post-migration stress. Comprehensive programs combining repatriation, emotional well-being and job security will promote the effective retention and reintegration of physicians. Strengthening psychosocial support will be key to consolidating a more resilient health system with motivated professionals committed to their return to Peru. Social implicationsMedical migration impacts equity in access, deepening regional inequalities. The repatriation of professionals should not be limited to labor aspects but must integrate psychosocial and mental health support, ensuring dignified and sustainable reintegration. Emotional support for migrants and their families contributes to social cohesion, strengthens human capital and builds trust in the health system. Promoting safe working conditions, adequate housing and psychosocial assistance favors both the retention of professionals and equity in healthcare for the most vulnerable populations. Originality/valueThis work documents a notable growth in medical emigration from Peru over the past five years, placing the trend in the wider context of health workforce issues. It emphasizes the roles of geographic origin and educational background as key factors, while stressing the influence of age.
PurposeThis paper examines the implementation of Territorial Health Groups (THGs) under Morocco's healthcare reform via Framework Laws 06-22 and 08-22. The study assesses how THGs can improve access, quality and efficiency of healthcare services, identify governance challenges and explore conditions for effective and sustainable territorial health governance.Design/methodology/approachThe study adopts a qualitative, exploratory approach with three objectives: (1) to examine public management theories as the theoretical foundation for THG governance; (2) to analyze the regulatory framework, including institutional arrangements, management instruments and digital tools and (3) to review international health-sector decentralization reforms in France, Spain, Canada, Indonesia and Algeria, adapted to Morocco's socio-economic and institutional context. Data were drawn from legal texts, ministerial reports, academic literature and comparative case studies.FindingsTHGs can enhance territorial equity, strengthen managerial autonomy and support participatory, data-driven governance. Their effectiveness depends on addressing structural challenges, including uneven human resource distribution, limited digital infrastructure and unclear accountability mechanisms. The study proposes a THG governance model with performance indicators, highlights implementation risks and success conditions and provides clear, actionable recommendations, summarizing the key findings to advance Morocco's THG system. International experiences emphasize the importance of national coordination, interregional equalization mechanisms, integrated care pathways and phased implementation.Research limitations/implicationsLimited THG data restrict the analysis to secondary sources; future research should include interviews and regional case studies.Practical implicationsRecommendations include a phased rollout, equitable resource allocation and stakeholder engagement.Originality/valueThe study integrates theory, regulation and international evidence to provide a theoretically grounded governance framework that supports evidence-informed, equitable and sustainable decentralization of Morocco's health system.
PurposeTelehealth is increasingly recognized as a transformative tool in healthcare delivery, particularly in low-resource settings. However, empirical evidence on its impact, especially in educational contexts within developing countries, remains limited. This study's objective is to investigate the influence of telemedicine and telehealth education on healthcare outcomes from the perspective of postgraduate students in Nigeria's first-generation universities.Design/methodology/approachA mixed-methods design was employed, integrating quantitative survey data from 380 postgraduate students and qualitative insights from 38 Key Informant Interviews (KIIs). The Perceived Impact of Telemedicine Questionnaire (PITQ) assessed perceptions across three domains: healthcare outcomes, telemedicine usage, and telehealth education. Quantitative data were analyzed using descriptive statistics and logistic regression, while qualitative data underwent thematic analysis guided by the Consolidated Framework for Implementation Research (CFIR).FindingsParticipants reported generally high levels of perceived impact across all domains (mean scores: 2.85-2.93). Logistic regression indicated positive but statistically non-significant effects of both telemedicine (p = 0.071; OR = 1.76) and telehealth education (p = 0.118; OR = 1.54) on healthcare outcomes. Thematic analysis revealed strong support for digital health integration, alongside barriers such as infrastructure limitations and policy gaps.Research limitations/implicationsSeveral limitations affect the study's findings. This may reflect limited statistical power, possibly due to a small sample size or data collection constraints. Wide confidence intervals including the value of 1 (see Table 8) suggest the effects may lack robustness across contexts. The use of self-reported data introduces subjectivity, potentially affecting accuracy. Additionally, focusing on first-generation university students in a developing country limits generalizability. Future research should use larger, more diverse samples, include objective measures, and explore broader populations to better assess telehealth effectiveness.Practical implicationsAlthough statistical evidence of impact was inconclusive, both telemedicine and telehealth education show promise in enhancing healthcare access and professional preparedness. The findings underscore the need for expanded digital health infrastructure and curriculum integration to support Sustainable Development Goals (SDGs) on health and education in low-resource settings.Social implications Strengthening telehealth education within universities has important social implications for healthcare delivery and workforce preparedness. Incorporating practical, hands-on training and simulation-based learning can help bridge the gap between theoretical knowledge and real-world clinical practice. Improved telehealth literacy among future healthcare professionals could contribute to more equitable access to care, particularly in underserved and remote communities. Addressing technical limitations, internet connectivity challenges, and user training needs through collaborative efforts between academic institutions and healthcare providers may further enhance the societal acceptance and sustainability of telemedicine services.Originality/value This study adds value to the existing literature by examining telemedicine from an educational and outcome-oriented perspective, highlighting the relationship between telehealth training, user perceptions, and healthcare delivery effectiveness. Unlike prior studies that focus primarily on clinical implementation, this research emphasizes the role of structured telehealth education in shaping acceptance and utilization trends. The findings provide novel insights into the potential yet currently statistically limited impact of telemedicine, underscoring the need for system-level improvements in infrastructure, training, and interdisciplinary collaboration.
PurposeCommunication has long been identified as an integral element that defines healthcare's quality operations and patient safety. This study focuses on the patient and healthcare staff interaction during COVID-19 and the investigation of communication aspects affecting safety and quality of care, as collected from the National Inpatient Experience Survey (NIES) in Ireland from 2017 to 2019 and 2021 to 2022.Design/methodology/approachThis is a secondary analysis study of quantitative data based on the most recent questionnaire from the NIES. In total, 61,100 patients in Irish hospitals answered to the questions of this survey over the five-year period, with a response rate ranging from 41% to 51%.FindingsMost of the communication questions exhibited statistically significant differences when comparing the COVID-19 to the pre-pandemic period. As per the study's participants, there were more aspects of communication that deteriorated during the mandatory mask-wearing period than those who saw improvement. Also, certain aspects of communication were identified to be more frequently related to other aspects of communication, and these are trust, time, involvement, details of operations/procedures and details of diagnosis/treatment/instructions. Regarding the genders, female patients exhibited a stronger interest in more communication questions and appeared less satisfied than males. Also, younger patients appeared less satisfied with their interaction with healthcare staff.Originality/valueFurther research on patient-healthcare staff communication barriers is needed, especially in high-pace and noisy units and when measures such as mask wearing in extensively used. Evidence-based research should be able to update processes, education and training and/or create new technology to overcome these communication barriers and prepare for a possible new pandemic.
PurposeTo explore clinicians' conceptualization of the value of medical technology, clinicians play an important role in the adoption of medical innovations. Therefore, understanding their perceptions will make it possible to obtain key insights into the conditions that are required for technology to be successfully integrated in the healthcare field. Design/methodology/approachQualitative study based on 32 semi-structured interviews at a major Swedish university hospital. Participants included clinicians and key stakeholders involved in thrombectomy and osseointegrated prostheses. Thematic analysis of the data was used to identify the ways in which clinicians conceptualize value across multiple stakeholder perspectives and benefits. FindingsThe clinicians expressed a varied understanding of value from various perspectives, including societal, organizational, professional and patient. The overarching perspectives were consistent across settings; however, depending on the clinical context, the benefits associated with each perspective revealed both shared conceptualizations and context-specific variations. In the case of osseointegrated prostheses, professional value also showed temporal variation, shifting from early emphasis on research and networking to a later focus on collaboration and patient-centered contributions. Originality/valueThis study makes an original empirical contribution by demonstrating the complexity and temporal nuance in clinicians' value conceptualizations. The study shows that clinicians engage holistically with multiple value dimensions, albeit differently and with an implicit hierarchy, and that perceptions may evolve with technological maturity.
PurposeThis study assesses the health systems' technical efficiency in attaining the Universal Health Coverage (UHC) target in 16 Southeast and South Asian countries. The study uses an output-oriented Data Envelopment Analysis (DEA) to evaluate the health systems' technical efficiency. The UHC Service Coverage Index, which assesses the service coverage and financial protection, is applied to the output variable. In contrast, major input variables comprise the per capita health expenditure, and physician density, nurses and midwifes density and hospital bed density, reflecting available resources for service delivery. This approach enables an in-depth evaluation of how efficiently health systems utilize available resources to achieve better UHC Service Coverage Index outcomes.Design/methodology/approachThe study applies a Tobit regression model to gain deeper insights, provide valuable recommendations for policymakers, and understand the role of socio-economic and environmental factors linked to efficiency assessments and in shaping health system performance.FindingsThe study reveals that many South and Southeast Asian countries operate at high technical efficiency. However, notable inefficiencies persist, particularly in Southeast Asia. Overall, health systems in South Asia are more effective in utilizing resources to achieve progress toward UHC than those in Southeast Asia. Indonesia, Sri Lanka and Brunei Darussalam demonstrate lower efficiency levels, implying the need to enhance resource allocation and health system governance rather than exclusively boost health investments. Variations in efficiency across countries highlight the significance of adopting customized health system policies.Originality/valueWith increasing global emphasis on UHC, assessing health systems' efficiency is critical. This research highlights disparities, identifies key efficiency drivers and underscores the role of governance and resource optimization - providing valuable evidence to guide region-specific policies for achieving equitable and sustainable UHC.
Purpose - Hospitals, as social institutions that provide health services to the community under its coverage, are one of the pioneer institutions that encourage and use social participation in the management and implementation of public governance. The leading countries in hospital quality improvement and management have generally moved towards models of hospital administration under public guidance and supervision or so-called public governance. This research will be carried out to provide a public governance model for Iran's hospitals, focusing on the management of hospitals with the participation of the people. Design/methodology/approach - This research followed a mixed-method design to develop a public governance model for hospitals in Iran. First, the components of public governance for hospitals in Iran are identified by reviewing the literature and experiences of other countries, and then, the viewpoints of experts regarding the components of public governance for hospitals in Iran are collected through qualitative methods such as focus group discussion and interviews. Based on the findings of the literature review and qualitative methods, the initial model of the public governance model for hospitals in Iran will be developed, validated and finalized using the Delphi technique. Finally, the evaluation indicators of the designed model will be extracted. Findings - The results of this research will provide policymakers and senior managers of the health system with valuable information to improve the performance of the public governance system in the health system of the country. To achieve this goal, the comprehensive evaluation tools are required. Research limitations/implications - This study protocol may face limitations in its applicability to healthcare systems outside Iran due to differences in organizational, cultural and political contexts. The qualitative methods and Delphi technique, while ensuring depth and expert input, might lead to subjective interpretations and potential biases in the final model. Additionally, the reliance on expert consensus may not fully capture all stakeholder perspectives. Future research will need to validate the proposed model in diverse healthcare settings and incorporate a broader range of stakeholders to ensure its generalizability and impact on global healthcare governance practices. Practical implications - This study will provide a comprehensive framework for implementing public governance in Iranian hospitals, emphasizing stakeholder participation and transparency in decision-making. The proposed model, once validated, can serve as a practical tool for policymakers and hospital administrators to enhance accountability, optimize resource allocation and improve service quality. By introducing clear evaluation indicators and implementation guidelines, the study aims to address existing management challenges and align hospital operations with public expectations. The findings will offer actionable insights that can be adapted to similar contexts, contributing to the development of more effective and equitable healthcare management practices. Social implications - The proposed study will have significant social implications by introducing a governance model that prioritizes inclusive and participatory decision-making in hospital management. By involving various stakeholders, including patients and community representatives, the model aims to foster greater public trust and accountability. Its implementation will likely lead to improved healthcare service quality, equitable access and enhanced satisfaction among users. This participatory approach is expected to contribute to more sustainable healthcare systems, promote social justice and address disparities in healthcare delivery, ultimately benefiting broader society by aligning governance practices with public welfare and shared responsibilities. Originality/value - This study contributes to the advancement of healthcare governance by proposing a novel public governance model for hospital management, integrating the perspectives of multiple stakeholders. Unlike traditional models, this approach emphasizes stakeholder collaboration, transparency and accountability to enhance service quality and satisfaction. By employing systematic, qualitative and Delphi methodologies, the study identifies and prioritizes comprehensive evaluation indicators tailored to the healthcare context. The findings offer valuable insights for policymakers, hospital managers and researchers seeking innovative strategies to address governance challenges in the health sector, ultimately fostering sustainable and people-centered healthcare systems.
PurposeThis article interrogates the persistent contradictions in global health governance between neoliberal, market-oriented approaches and the universal right to health. It seeks to clarify how key global actors promote equity in principle while advancing market-driven frameworks that commodify healthcare.Design/methodology/approachThe study adopts an interpretive and conceptual research design, relying exclusively on secondary sources, including academic literature, institutional reports and global policy documents. While adopting interpretive research design, the article's value lies in synthesising diverse strands of literature and practice into a cohesive conceptual framework, offering an agenda-setting contribution that complements ongoing empirical studies.FindingsThe article finds that rights-based frameworks risk fiscal overextension if detached from sustainable financing, while market mechanisms can stabilise provision but only by narrowing access and institutionalising inequity. These unresolved trade-offs, between equity and sustainability, universality and scarcity, constitute the central governance dilemma.Originality/valueThis article contributes a cohesive conceptual framework that integrates fragmented debates on health rights and neoliberal governance. By reinterpreting global health through the lens of governance trade-offs, it advances an agenda-setting perspective for reform.
PurposeThis paper aims to investigate how retirement and its duration affect functional health, using grip strength as an early biomarker of ageing. It examines the implications of pension policy and cultural context for physical functioning among older adults in Europe.Design/methodology/approachWe analyse panel data from the Survey of Health, Ageing and Retirement in Europe, covering 2004-2019. A fixed effects instrumental variable (FE-IV) approach is employed, using eligibility for state pension age as an exogenous instrument to address endogeneity in retirement status.FindingsRetirement improves grip strength, particularly among older women and in individualistic welfare regimes. However, extended time in retirement leads to functional decline, especially among men and in collectivist societies. These patterns suggest both health-promoting and health-risk phases within retirement, shaped by policy and cultural environments.Originality/valueBy linking pension eligibility rules with functional health outcomes across countries, this study provides governance-relevant evidence for designing retirement systems that support healthy ageing. Findings highlight the need for integrating physical resilience programs within retirement policy, tailored to national contexts and cultural norms, to reduce long-term health risks and promote equity in ageing.
