Purpose Women's representation in healthcare leadership roles in Canada is increasing, yet limited prospective data exist on their perceptions of empowerment, organizational support, job satisfaction, engagement and well-being. This study explored how women in director-level or higher positions describe their work experience. Design/methodology/approach A quantitative cross-sectional study was conducted from February to May 2025. Participants held director-level positions or higher and were recruited from Health Authorities across British Columbia. A total of 185 participants who self-identified as a woman completed an online questionnaire including demographic items and the Picker Employee Questionnaire (PEQ). Data were exported from Qualtrics© and analyzed using SPSS (IBM version 27). Descriptive statistics were used to analyze demographic information and their work experience. Inferential statistics was used to examine relationships and group differences. Findings Overall, women reported positive, compassionate and inclusive work environments with strong safety and health scores. Engagement was lower than morale and teamwork. Protective factors against intent to leave included compassion, inclusivity, voice and safety. Organizational support, empathy and psychological safety promoted engagement, while excessive work pressure was a major risk factor. Originality/value Women healthcare leaders generally experience supportive workplaces, but reducing work pressure and enhancing engagement remain critical for retention and well-being.
PURPOSE:The COVID-19 pandemic challenged and transformed the healthcare workplace and the interconnections between leaders and frontline workers, and interprofessional configurations thus necessitated holistic psychometric studies that encompassed frontline workers and leaders. Within a conceptual framework combining job demands-resources and open systems theories, two studies (2023 and 2025) assessed the validity and reliability of measures of burnout, resilience, leadership behavior, interprofessional relationships, workplace environment and outcomes (turnover, job satisfaction, patient outcomes and performance) for frontline healthcare workers (N = 209) and leaders (N = 101). DESIGN/METHODOLOGY/APPROACH:In study 1 (2023) we assessed validity and tested reliability evidence using exploratory and confirmatory factor analysis (EFA/CFA), convergent validity, discriminant validity, Cronbach's alpha, intercorrelation analysis and composite reliability for burnout and resilience in phase 1. EFA, convergent validity, discriminant validity, Cronbach's alpha and intercorrelation analysis, for interprofessional relationships and leadership behaviors covering frontline healthcare workers in phase 2; and healthcare leaders in phase 3, respectively. In study 2 (2025), we assessed the content and face validity of each question. FINDINGS:We established evidence of validity and reliability for measures of burnout and resilience for frontline healthcare workers and leaders, interprofessional practice and perceived leadership behavior scales among frontline workers and interprofessional healthcare practice leadership and managers' leadership behavior scales. Further, content and face validity were confirmed for all constructs. ORIGINALITY/VALUE:Our contributions include the following: a more comprehensive and integrated psychometric toolkit with crisis-assessment utility, the extension of validation work across two healthcare groups and role-specific, validated measures of burnout, resilience and interprofessional practice leadership for healthcare leaders.
PURPOSE:Drawing on New Public Management this study examines whether senior hospital managers' professional training profiles are associated with their use of management control systems in public hospitals. It examines whether medically trained, managerially trained and hybrid clinical-managerial executives differ in their use of Simons's four levers of control - belief, interactive, diagnostic, and boundary systems - and how these levers relate to care-related and managerial objectives. DESIGN/METHODOLOGY/APPROACH:A cross-sectional survey of 58 senior managers in Ecuadorian public hospitals covered 50.4% of the hospitals registered with the Ministry of Public Health at the time of data collection. The hypotheses were tested using partial least squares structural equation modelling (PLS-SEM). The analysis assessed measurement reliability and validity, effect sizes and out-of-sample predictive performance. Given the moderate sample size and single-source design, the findings are interpreted as exploratory. FINDINGS:Medical training was associated with greater use of belief and interactive systems and with less use of diagnostic and boundary systems. Hybrid clinical-managerial training was associated with the use of all four levers. Belief and interactive systems were positively associated with care-related objectives, whereas diagnostic and boundary systems were positively associated with managerial objectives. ORIGINALITY/VALUE:The study links professionalism, management control systems, and public-sector healthcare in an under-researched Latin American setting. It shows how hybrid training may support a broader repertoire of control practices in centralised, resource-constrained public hospitals.
PURPOSE:The rapid proliferation of artificial intelligence (AI) applications in healthcare is transforming the ways in which employees interact with technology, making it crucial to understand the effects of this process on employee behavior. The purpose of this study is to examine the effects of openness to organizational change and attitudes toward AI on employees' innovative behavior, and to test the mediating role of technostress in these effects. DESIGN/METHODOLOGY/APPROACH:The research was conducted using a quantitative research design. Data were collected via face-to-face surveys from 305 healthcare workers employed at a university hospital in Istanbul, Türkiye, between January and February 2026 and analyzed using structural equation modeling. SPSS and AMOS software were used to analyze the collected data. FINDINGS:The findings revealed that employees with high levels of openness to organizational change and a positive attitude toward AI experienced lower levels of technostress, and that this, in turn, increased their innovative work behavior. Additionally, it was determined that technostress plays a partial mediating role in the effects of openness to organizational change and a positive attitude toward AI on innovative behavior. RESEARCH LIMITATIONS/IMPLICATIONS:In conclusion, it has been demonstrated that employees' perceptions of technology and their openness to change shape innovative behavior through technostress in AI-driven transformation processes. ORIGINALITY/VALUE:This study contributes to the literature by integrating digital transformation, organizational behavior, and health management; it also provides practical implications highlighting the importance of employee-centered digital transformation strategies for healthcare organizations and policymakers.
PurposeThe 2030 Agenda highlights the transformative role of digital technologies in advancing human progress, reducing inequalities and promoting sustainable knowledge societies. Digital Health (DH) enhances healthcare effectiveness, resilience and equity, while addressing environmental and climate challenges. To fill a literature gap, we conducted a scoping review of methodologies for DH impact assessment, focusing on social and environmental dimensions aligned with the six aims of Value-Based Health Care (VBHC). Design/methodology/approachThe review followed JBI methodology and PRISMA-ScR guidelines. PubMed, Scopus and Cochrane searches (2014–2024, English) retrieved studies addressing at least three domains of the Sextuple Aim: Experience of Care, Population Health, Reduced Cost, Care Team Well-Being, Health Equity, and Environmental Impact. FindingsFrom 8,243 records, 53 studies met criteria. None addressed all six aims. Experience of Care (98.11%) and Population Health (94.34%) dominated assessments, whereas Environmental Impact appeared in 11.32%. Thematic analysis yielded 128 items across 10 domains, 26 topics, and 92 issues. Experience of Care, notably user engagement and process costs, was most developed. Environmental Impact remained limited to carbon footprint and transparency. Social implicationsBy highlighting key gaps, the review supports balanced, evidence-based DH decision-making and helps stakeholders prioritize innovations delivering technical, social and environmental value. Originality/valueThis is the first systematic mapping of DH's social and environmental evaluation within the Sextuple Aim, resulting in a Holistic Impact Framework integrating underrepresented dimensions.
Purpose This study aims to understand how public healthcare organizations build a sustainable wellbeing capability under resource constraints. It examines how organizational, human, social and temporal resources are bundled, how compassionate leadership translates formal wellbeing intent into everyday practice, and how repeated routines become credible under pressure. Design/methodology/approach An embedded qualitative case study was conducted in a regional Australian health district comprising eight hospitals. Data were collected between 2019 and 2021 through semi-structured interviews with 51 clinical, managerial, and administrative participants, observations, field notes, and internal documents. Analysis followed an abductive and comparative approach informed by Resource-Based Theory, process theorizing and qualitative case-study principles. Findings Wellbeing capability emerged not from isolated wellbeing programs but from repeated alignment among HR systems, workforce planning, compassionate leadership and relational routines. Organizational capital mattered when rostering, behavioral expectations and recognition processes were experienced as fair and operationally realistic. Human capital mattered when compassionate leaders noticed strain, practiced gratitude and legitimized reflection. Social capital mattered when debriefing, mentoring and shared problem-solving became routine. Temporality mattered because repeated practices accumulated credibility and were stress-tested during COVID-19 disruption. Originality/value The paper distinguishes employee wellbeing from organization-level wellbeing capability and extends Resource-Based Theory by showing how resource orchestration works in public healthcare through role-modeling, routine embedding, procedural scaffolding, reciprocity loops and temporal accumulation. It positions compassionate leadership as a capability-building translation mechanism and clarifies how time, repetition and disruption shape whether wellbeing routines become credible organizational capability.
PurposeManagement in health care organisations is generally shaped by the interplay between managers' actions and the institutional logics in which organisations are embedded. However, during the COVID-19 pandemic this interplay changed significantly and research on how such shifts evolve over time remains limited. The aim of this study is to contribute to an understanding of how the interplay between institutional logics and managers' actions shape management and creates both constraints and opportunities for generating organisational change or stability in a Swedish hospital before, during, and after the COVID-19 pandemic. Design/methodology/approachThe study is based on 15 in-depth, semi-structured interviews with managers from several hierarchical levels who were responsible for handling the COVID-19 pandemic in a regional hospital in Sweden. The interviews were transcribed, and the study employed an abductive, thematic analytic approach. Theoretically, the study draws on strong structuration theory in conjunction with institutional theory. FindingsThe findings reveal a sequential shift in institutional logics. Before the COVID-19 pandemic, managerial logic dominated, was reproduced by managers' and created organisational stability while constraining managers' actions. During the crisis, managers' replaced managerial logic with professional logic, enabling greater autonomy and organisational change. After the crisis, managerial logic was reinstalled, again limiting and managers' actions restoring the previous organisational order. The study also identifies the conditions that enable such shifts and demonstrates that changes in institutional logics are also linked to power relations tied to managers' hierarchical positions. Originality/valueThis study contributes to a deeper understanding of how shifts in management occur during a crisis, creating organisational change or stability within a hospital. This study also advances understanding of how management and organisations evolve, change or remain stable over time, and underscores the need for greater awareness of strategies that enhance the organisational capacity to prepare for and respond to uncertain, demanding, and complex situations. This study also contributes theoretically by demonstrating how the application of strong structuration theory, in conjunction with institutional theory, can be employed within management research in the health care sector.
Purpose Previous research identifies multiple motives as drivers of value co-creation but reports inconsistent findings across national contexts. This study examines how national culture shapes healthcare service users’ motives and engagement in value co-creation, addressing calls to better contextualize service interactions in healthcare. Design/methodology/approach We adopt a conceptual research design and develop an integrative framework that brings together service-dominant logic, value co-creation motives, healthcare service provider–user relationship dynamics, and cultural value dimensions. We discuss a set of propositions that explain how culture and relationship expectations influence active and passive co-creation behaviors. Findings Drawing on our findings, we develop a framework that reconciles several persistent inconsistencies instead of introducing additional isolated explanations. This framework indicates that these discrepancies primarily reflect culturally embedded expectations regarding authority, autonomy, and uncertainty, which shape healthcare relationships. Engagement motives and behaviors are not universally activated; rather, they become salient only when aligned with culturally informed relationship norms and expectations. Consequently, the same co-creation practice may foster empowerment and collaboration in one healthcare setting, yet generate discomfort, passivity, or resistance in another. Practical implications Healthcare organizations may benefit from adapting engagement practices, communication styles, and decision-making processes to culturally grounded expectations in order to support service user involvement and well-being. Originality/value The paper provides an integrated perspective on culturally embedded drivers of value co-creation in healthcare service interactions. The study contributes to the existing literature by conceptualizing national culture as a boundary condition that influences co-creation motives and relationship dynamics in healthcare services. Our framework helps explain inconsistent findings in existing research conducted in different national contexts. It extends existing value co-creation theory by incorporating cultural context.
Purpose Patient safety is a critical component of healthcare quality. Hospital falls are a frequent and harmful event, with multifactorial causes and significant consequences for both patients and healthcare systems. Despite the widespread use of incident reporting systems (IRS) as a risk management tool, challenges such as underreporting, poor data quality, and fragmented analytical approaches persist, limiting their effectiveness. To address these gaps, this study proposes a theoretical maturity model (MM). Design/methodology/approach The proposed MM was developed based on a systematic literature review (SLR), conducted according to Joanna Briggs Institute and Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. An inductive thematic analysis identified core capabilities required for effective hospital falls management. These were integrated into a conceptual MM supported by a data collection instrument and a fuzzy multi-criteria decision-making (MCDM) approach. Findings Based on the synthesis of the SLR findings, a conceptual MM was developed to assess healthcare organizations' maturity levels in hospital fall management. The model enables the identification of organizational gaps, prioritization of improvement actions and guidance on decisions aligned with patient safety objectives. It includes a data collection instrument and applies a fuzzy MCDM approach to aggregate information. An illustrative example demonstrates the model's potential applicability and functionality. Originality/value This theoretical MM offers a structured foundation for future research, tool development and practical applications in clinical settings. By integrating fall-related factors, reporting quality and system characteristics, the model promotes a comprehensive and strategic approach to fall management. It moves beyond isolated interventions and supports the coordinated enhancement of patient safety across healthcare institutions. Highlights
PURPOSE:This study aims to analyse patterns of professional availability among nurses working in the Portuguese National Health Service (NHS), using administrative data for the year 2024, with a specific focus on absence typologies classified under the administrative category "Other". DESIGN/METHODOLOGY/APPROACH:A quantitative, descriptive-analytical approach based on official administrative data was adopted. The analysis focused on identifying profiles of association between absence typologies and absence duration, as well as on characterising profiles of professional unavailability. FINDINGS:Absenteeism was primarily structured according to both the duration and the typology of absence, which allowed the identification of three distinct profiles of professional unavailability: (1) short, occasional absences associated with functional adjustments in work organisation; (2) short-term absences related to civic participation and community service activities and (3) prolonged absences associated with personal development and temporal flexibility. RESEARCH LIMITATIONS/IMPLICATIONS:The data refer to a single calendar year, which constrains the analysis of temporal dynamics. Future research may benefit from longitudinal designs and interannual comparisons. PRACTICAL IMPLICATIONS:The findings provide relevant evidence for strategic human resource planning in healthcare, highlighting the need for differentiated approaches to absenteeism management. SOCIAL IMPLICATIONS:Absenteeism is interpreted as an indirect indicator of professional availability, with implications for the Sustainable Development Goals (SDG) related to decent work, health and well-being and the reduction of inequalities. ORIGINALITY/VALUE:This study draws on national administrative data and addresses a domain that remains underexplored in the literature on health organisation and management. The "Other" category is particularly relevant from a management perspective, as it includes forms of absence that are less predictable and may require short-notice adjustments in staffing, with direct implications for workforce planning and service continuity.
PurposeTo evaluate: (1) the effectiveness of team-based (quasi-)experiments developed with appreciative inquiry on job resources, team crafting, work engagement and vigour among healthcare professionals and (2) associations between the experimental process and changes in these outcomes. Design/methodology/approachIn a Dutch elderly care organisation, 174 participants and 495 non-participants were invited to complete baseline and three-month follow-up surveys. Participating teams designed a total of five quasi-experiments targeting job resources. Effectiveness was analysed using Kernel-based propensity score matching, and associations between the experimental process and outcome changes were analysed using linear regression adjusted for baseline values and covariates. FindingsParticipation in experiments increased colleague social support. Workers more satisfied with experiment-related supervisor support showed greater improvements in work engagement, vigour, development opportunities, feedback about work and social support and coaching from supervisors. Workers more satisfied with the experiment’s effects and its alignment with their needs reported improved social support from supervisors. Practical implicationsUsing appreciative inquiry to collaboratively develop team-based experiments aimed at enhancing job resources may improve colleague social support among healthcare professionals. When supervisors provide more experiment-related support, work engagement and vigour might also improve. Originality/valueThis is the first quasi-experimental study on the effectiveness of appreciative inquiry implemented within a regular work practice of healthcare workers. This design facilitated stronger causal inferences on the conditions under which appreciative inquiry might be effective, and allowed conclusions about the effects expected in similar work contexts.
Purpose Value-based health care proposes that hospitals implement condition-based units (CBUs) to enhance patient value and foster collaboration among professionals. Although CBUs are proposed as an alternative to traditional functional hospital structures, many hospitals insert them within their existing functional structures. Using structural design theory as a framework, this study aims to examine the structure-related opportunities and challenges associated with CBUs integrated within functional hospital structures in order to understand how this integration affects their ability to improve patient value and collaboration. Design/methodology/approach A qualitative multiple case study was conducted with members of 6 CBUs across 2 Dutch hospitals, involving 26 interviews analyzed thematically. Findings Our findings show that the functional structure provides CBUs with resources and specialized expertise, including support on project management and data analysis. However, integrating CBUs within the functional structure can lead to ambiguity in decision-making authority within CBU processes, involve multiple stakeholders in CBU-related decisions and generate tensions between departmental and CBU goals. Practical implications We recommend that hospital managers adopt a learning-oriented, experimental approach to gradually integrate care delivery and decision-making within CBUs, while positioning the functional structure as a supportive infrastructure. Originality/value By identifying structure-related opportunities and challenges, this study addresses the lack of understanding regarding the consequences of implementing CBUs within functional hospital structures and indicates the need for hospitals to take additional measures to leverage opportunities and address associated challenges to maximize the potential of CBUs.
Purpose This study systematically reviewed the role of smartphone-based mobile health (mHealth) applications in supporting emergency healthcare delivery in resource-constrained, geographically isolated, and crisis-affected settings. The review addressed fragmented evidence regarding the contribution of mHealth to emergency care efficiency, clinical decision-making, workflow coordination, and implementation readiness. Design/methodology/approach A systematic review was conducted using the PRISMA framework and guided by the SPIDER tool. Articles published between 2014 and 2024 were retrieved from ScienceDirect, PubMed, IEEE Xplore, and BMJ. Sixteen eligible studies were included after screening and quality appraisal. Braun and Clarke's reflexive thematic analysis was employed to synthesize qualitative, quantitative, and mixed-method evidence. Findings Three overarching themes emerged: the integration of mHealth into emergency services, the impact of mHealth applications on emergency case management, and the implementation challenges during adversity. Findings suggest that smartphone-based mHealth applications may improve communication, triage coordination, remote consultation, patient monitoring, continuity of care, and evidence-based decision-making. However, implementation remains constrained by unstable digital infrastructure, interoperability limitations, cybersecurity concerns, inadequate digital literacy, workflow integration difficulties, and weak regulatory governance. Originality/value This review provides an analytical synthesis of the operational, technological, clinical, and implementation dimensions of smartphone-based mHealth in emergency care. The findings position mHealth not merely as a supplementary tool but as a strategic mechanism for strengthening emergency preparedness, healthcare responsiveness, and system resilience during adversity.
PurposeThis paper reviews the literature on workplace mistreatment faced by healthcare professionals and the coping mechanisms they suggest. Design/methodology/approachWe conducted a systematic literature review using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines to identify articles relevant to the topic of investigation. English-language articles focusing on the mistreatment experienced by healthcare professionals in Web of Science or Scopus-indexed journals published from 1996 to 2025 are selected for review. These articles were analyzed through the AMO (antecedents, mediators and outcomes) and 5 W (What, Who, When, Where and Why) +1H (How) frameworks. FindingsOut of the initial 1,973 articles, we identified 76 articles meeting our inclusion criteria. Using these articles, we prepared a conceptual framework that includes the antecedents and mediators, divided into individual, organizational and other factors. The outcomes were divided between individual levels (physical, psychological and job) and organizational levels. The coping strategies used by the healthcare professionals and organizations were reviewed, along with study implications and future research directions. Originality/valueThis article reviews and synthesizes the literature on mistreatment faced by healthcare professionals from coworkers, supervisors, patients and patients' families. Along with this, we have reviewed the coping strategies suggested by the healthcare professionals.
Purpose Artificial intelligence (AI) has the potential to revolutionize preventive healthcare by enabling early risk detection, patient stratification and support for clinical decision making. However, its implementation in real-world settings remains inconsistent, primarily due to ongoing organizational challenges. Guided by the population, intervention, comparison and outcome (PICO) and preferred reporting items for systematic reviews and meta-analyses (PRISMA) frameworks, this study aims to identify the organizational factors that influence the successful adoption of AI technologies in preventive care. Design/methodology/approach This study adopts the PRISMA flow and reviews 536 peer-reviewed articles that met the PICO-defined criteria: healthcare organizations (population), adoption or use of AI technologies (intervention), no comparator required (comparison) and organizational adoption factors (outcomes). Using an AI-assisted screening process combined with thematic analysis, we categorized organizational influences into 12 key topics. These were analyzed through the lens of the organizational readiness for change (ORC) framework. Findings The findings highlight that adoption success hinges on strategic leadership, workforce preparedness, effective data governance, seamless workflow integration and robust ethical oversight. Persistent challenges include fragmented infrastructures, limited trust, and regulatory uncertainty. Originality/value This study advances the field in three respects: it focuses specifically on preventive healthcare as an organizational context; it applies the ORC framework as an integrating theoretical lens across a large, synthesized corpus, and it employs a transparent human–AI-assisted screening process that supports large-scale evidence synthesis while preserving author oversight.
PURPOSE:The study investigates whether risk-taking functions as a strategic capability that improves firm performance in public hospitals that operate in resource-constrained healthcare systems. DESIGN/METHODOLOGY/APPROACH:Data were collected through survey method from 151 public hospitals. A multivariate general linear model was used to analyse the effect of risk-taking on organisational effectiveness and organisational relevance. Hospital level, bed capacity and number of personnel in the public hospitals were used as control variables. FINDINGS:The study revealed that risk-taking has a significant multivariate effect on organisational performance. Specifically, risk-taking positively influences organisational effectiveness of public hospitals. Risk-taking does not significantly influence organisational relevance once the controls are included. RESEARCH LIMITATIONS/IMPLICATIONS:The study adopted a cross-sectional research design, which limits causal interpretation. Future research should engage longitudinal study designs and incorporate objective performance indicators such as return on assets to strengthen causal understanding. PRACTICAL IMPLICATIONS:The findings suggest that organised entrepreneurial commitment in an organisation, can improve internal service provision performance devoid of essentially undermining institutional mission and vision. This occurs when entrepreneurial commitment is embedded within appropriate governance structures. ORIGINALITY/VALUE:The study improves the understanding of risk-taking as a strategic capability in public hospitals and further reveals that, in order to enhance performance in organisations, organisational characteristics such as the number of personnel should be understood.
PURPOSE:Strengthening holistic care competencies among the healthcare workforce has become an important strategy for promoting people-centered health systems. Teaching hospitals play a central role in workforce training; however, differences in institutional context across hospital levels may influence workforce adoption. This study examines how institutional context shapes health workforce intention to adopt holistic care competencies in Taiwanese teaching hospitals. DESIGN/METHODOLOGY/APPROACH:A cross-sectional survey was conducted between July and December 2022 among clinical supervisors and postgraduate trainees from one medical center and one regional teaching hospital in Taiwan (n = 703). Drawing on the theory of planned behavior, the study measured attitudes, subjective norms, perceived behavioral control and behavioral intention toward adopting holistic care competencies. Independent-sample t-tests and multiple regression analyses were used to examine determinants of adoption intention. Structural differences between hospital levels were further tested using a Chow test. FINDINGS:Health workforce members in medical centers reported significantly stronger behavioral intention to adopt holistic care competencies than those in regional hospitals (mean = 3.88 vs. 3.78, p = 0.044). Among clinical supervisors, medical centers demonstrated significantly higher levels of attitudes, subjective norms, perceived behavioral control and behavioral intention. Across both hospital types, subjective norms and perceived behavioral control were the strongest predictors of adoption intention (medical centers: ß = 0.309 and 0.434; regional hospitals: ß = 0.240 and 0.561; p < 0.001). The models demonstrated substantial explanatory power (R2 = 0.556-0.637). Chow test results indicated significant structural differences between hospital levels (F = 19.85, p < 0.001), suggesting that institutional context shapes the determinants of workforce adoption. RESEARCH LIMITATIONS/IMPLICATIONS:This study has several limitations. First, the cross-sectional design limits causal inference. Second, the sample was drawn from two teaching hospitals in Taiwan, which may limit generalizability to other healthcare systems or institutional contexts. Future research could employ longitudinal designs and include a broader range of hospitals to further examine how institutional environments influence workforce adoption of holistic care competencies. PRACTICAL IMPLICATIONS:The findings highlight the importance of institutional support in promoting workforce adoption of holistic care competencies. Hospitals, particularly regional teaching hospitals, may strengthen adoption by providing structured training opportunities, mentorship programs and organizational recognition mechanisms. Aligning accreditation requirements with practical institutional support may also help translate policy expectations into sustainable workforce development practices. SOCIAL IMPLICATIONS:Promoting holistic care competencies among healthcare professionals may enhance patient-centered care by encouraging clinicians to consider patients' psychological, social and family contexts in addition to medical treatment. Strengthening workforce capacity in holistic care may therefore contribute to more responsive healthcare systems and improved patient experiences. ORIGINALITY/VALUE:This study contributes to health organization and workforce research by demonstrating how institutional context may influence the behavioral mechanisms underlying workforce adoption of holistic care competencies. The findings highlight the importance of institutional support and perceived behavioral control in shaping workforce adoption and suggest that targeted workforce development strategies are particularly needed in resource-constrained regional hospitals.
PURPOSE:This research examines how non-financial breaches of psychological contracts affect the migration intentions of healthcare professionals via employee well-being, considering emotional resilience as a moderating factor in this indirect relationship. DESIGN/METHODOLOGY/APPROACH:The survey design adopted (explanatory quantitative survey) was used to sample 572 healthcare providers in three teaching hospitals in Ghana. The hypothesised relationships were analysed using partial least-squares structural equation modelling (PLS-SEM). FINDINGS:Psychological contract breach has a significant positive effect on migration intentions, with this relationship operating indirectly through reduced psychological, social and workplace well-being. Furthermore, emotional resilience buffers the adverse effects of psychological contract breach on well-being and attenuates the indirect relationship with migration intentions. ORIGINALITY/VALUE:This study represents one of the first to empirically test a multidimensional well-being mediation model that relates non-financial psychological contract breaches to migration intentions in the context of a health system in Africa. The study combines a detailed analysis of well-being decomposition with conditional process analyses of emotional resilience and uses data from teaching hospitals across three ecological zones in Ghana to provide new theoretical evidence and cost-effective interventions that could inform retention strategies in similar low-resource settings.
PURPOSE:The purpose of this research is to investigate the impact of servant leadership on the job satisfaction of medical assistants (MAs) in healthcare organizations across the United States of America, focusing primarily on the mediating effects of work-life balance (WLB) and burnout. DESIGN/METHODOLOGY/APPROACH:This study adopted a quantitative, non-experimental, correlational and cross-sectional design. It utilizes Hayes's PROCESS model 4 with bootstrapping to test the hypotheses. Data were collected from 998 certified MAs in healthcare organizations in the United States of America using a purposive and convenience sampling method. FINDINGS:The study finds that servant leadership positively predicts job satisfaction and WLB and negatively predicts burnout; servant leadership has a partial mediating effect on job satisfaction in the presence of both mediators. RESEARCH LIMITATIONS/IMPLICATIONS:The purposive and convenience sampling procedure decreased the generalizability of the findings. While survey of a broader sample of MAs was attempted, only a small percentage of the respondents were from healthcare organizations, and a majority of the participants were from the professional organization, the American Association of Medical Assistants. Using a quantitative approach did not allow for gathering information as in-depth as could be obtained with qualitative research. Although the study was open to all genders among the target population, the results were oriented towards the female population, since a majority of MAs were female. PRACTICAL IMPLICATIONS:The findings from this study support that servant leadership influences the job satisfaction of MAs. Additionally, servant leadership can be utilized to improve compassion and understanding, increase communication, improve WLB and reduce burnout and maintain the well-being of MAs, which will significantly enhance the job satisfaction of the MAs. Furthermore, healthcare leaders and administrators may focus on creating a trusting relationship and empowering their MAs by displaying servant leadership characteristics. Overall, the research implications are that the perception of servant leadership positively impacts the job satisfaction of MAs. SOCIAL IMPLICATIONS:The study validates the servant leadership theory, which operates primarily on empathy, in which the leader is a servant first and primarily focuses on the needs of the subordinates, which resonates with the MAs who put others first (Liden et al., 2008). Next, the study validates the boundary theory with servant leadership supporting employees' well-being, with WLB as a mediator. The study also validates the job demands-resources model of burnout, demonstrating that burnout negatively impacts job satisfaction. ORIGINALITY/VALUE:The study examines whether servant leadership is a valuable leadership style positively impacting MAs' job satisfaction through improved WLB and reduced burnout. These findings support the theoretical frameworks applied and add to the existing literature of MAs, servant leadership and healthcare studies.
PURPOSE:This study aims to examine the effects of nurses' employee well-being on green organizational behavior, green organizational climate, and job performance, as well as the mediating roles of green organizational behavior and green organizational climate in the relationship between employee well-being and job performance. DESIGN/METHODOLOGY/APPROACH:This study was conducted as a cross-sectional survey of nurses working in three public hospitals. Data were collected from 561 nurses who completed valid questionnaires and were analyzed using structural equation modeling in SmartPLS 4. FINDINGS:The structural equation modeling results showed that employee well-being had a significant positive effect on both green organizational behavior and green organizational climate. In turn, green organizational behavior strongly influenced job performance, while green organizational climate also had a positive impact. Furthermore, employee well-being showed significant indirect effects on job performance through both green organizational behavior and green organizational climate, confirming the mediating role of environmental factors in translating well-being into performance outcomes. ORIGINALITY/VALUE:The findings extend social exchange theory and the theory of planned behavior by showing that employee well-being alone is insufficient to enhance performance unless it is channeled through supportive green behaviors and an enabling green climate. The study contributes theoretically by positioning green organizational behavior as a behavioral mechanism and green organizational climate as a contextual mechanism through which well-being is converted into performance outcomes, particularly in high-stress healthcare settings.
