Journal of Healthcare Leadership最新文献

The integration of artificial intelligence, particularly deep learning, has transformed cancer oncology through more precise diagnostics, personalized therapies, and improved clinical decision-making. This study conducts a bibliometric mapping to capture global research trends, intellectual influence, and conceptual structures in cancer oncology and deep learning. A total of 19,627 peer-reviewed articles published between 2022 and 2025 were analyzed, retrieved from an initial dataset of 34,218 documents. Using Correspondence Analysis (CA) and Multiple Correspondence Analysis (MCA) in RStudio, we evaluated both Author Keywords and Keyword Plus. The results highlight dominant themes, including multimodal learning and radiogenomics, while also uncovering emerging directions such as transformer-based models, federated learning for cross-institutional data, and the ethical dimensions of explainable AI in clinical workflows. MCA on Keyword Plus provided stronger explanatory power (80.01% and 8.76% for the first two dimensions) compared to CA on Author Keywords (5.27% and 3.73%). This mapping reveals critical gaps-such as limited participation from low- and middle-income countries, lack of standardized datasets, and insufficient multidisciplinary collaboration. By identifying these challenges and opportunities, the study provides actionable insights for researchers, policymakers, and clinicians to advance inclusive and ethically responsible AI-driven cancer research.

Purpose: Primary-care organizations must be resilient to keep essential services running during crises. The recent crisis in healthcare systems caused by the outbreak of the COVID-19 pandemic has triggered a global increase in interest in digital transformation and the concept of resilience in the healthcare sector. In this context, this study examines how two dimensions of digital transformation -Transformation Management Intensity (TMI) and Digital Intensity (DI)-affect job satisfaction (JS) in primary healthcare centres (PHCs) through the mediating role of organisational resilience (OR).

Methods: A survey was conducted among 400 managers of PHCs in Poland and the Netherlands using the CAWI method. Validated scales from the corporate sector were adapted. Reliability and convergent validity were confirmed (Cronbach's α > 0.80; AVE > 0.50). Structural equation modelling (SEM) was applied using SPSS v29 and AMOS v29 to test relationships between two DT dimensions (TMI, DI), OR and JS.

Results: TMI had a significant indirect effect on JS through OR (β = 0.562, p < 0.001), whereas DI had no significant indirect effect (p = 0.684). The direct effect of TMI on OR (β = 0.728, p < 0.001) and the effect of OR on JS (β = 0.772, p < 0.001) were both strong and statistically significant. In contrast, the direct effect of DI on OR was not statistically significant (p = 0.512).

Conclusion: This study advances previous research by empirically testing a mediation model in the underexplored context of PHCs during crisis. It offers novel evidence that TMI rather than DI alone enhances OR and supports JS. The results provide actionable insights for healthcare leaders seeking to strengthen workforce stability and crisis readiness through effective DT.

Importance: Inclusive leadership (IL) is posited to strengthen employee wellbeing and patient‑centered outcomes, yet findings in healthcare remain mixed.

Objective: To test direct effects of IL on job satisfaction (JS) and perceived quality of care (PQC) and to examine whether climate for inclusion (C4I) and cultural competence (CC) moderate these relationships.

Design setting and participants: Cross‑sectional survey of US healthcare managers recruited via a commercial opt‑in Email frame and professional networks (June-November 2024). N=209; complete‑case N=144.

Main outcomes and measures: JS (2‑item short index) and PQC (10‑item) on 5‑point Likert scales; predictors IL (8 items), C4I (16 items), CC (7 reverse‑coded items).

Results: Regression models supported H1-H6 (p<0.001). The three‑way IL×CC×C4I term was marginal for JS (H7a; p=0.064) and significant for PQC (H7b; p<0.001). Measurement reliability was excellent for IL (α=0.950), C4I (α=0.948), CC (α=0.930), JS (α=0.873), and PQC (α=0.923).

Conclusions and relevance: Inclusive leadership and cultural competence are associated with higher JS and PQC, with stronger effects under supportive inclusion climates. Programs that develop inclusive leaders and institutionalize inclusive norms may yield workforce and care benefits.

Introduction: Leadership is a complex and multidimensional concept that has been widely studied in the field of nursing, given its proven influence on the nursing practice environment, and on the quality and safety of the care provided. Identifying which leadership skills are necessary for effective leadership, and understanding how they can be developed, is extremely important, as, without them, it is difficult for nursing leaders to maintain favourable nursing practice environments. In this context, we highlight the relevance of the Self-Assessment Leadership Instrument (SALI), which was developed by Bonnie Smola with the aim of specifically measuring leadership behaviours in nurses and nursing students. In this study, the SALI was translated, cross-culturally adapted, and validated for the Portuguese cultural context.

Purpose: This study aimed to (1) culturally and linguistically adapt the SALI to Portuguese and (2) validate its psychometric properties, resulting in a Portuguese version of the instrument.

Methods: A cross-sectional quantitative methodological study was carried out. The scale was translated and adapted transculturally through a rigorous process and applied to the target population of two nursing colleges, with a total of 1590 nursing students.

Results: The Portuguese version maintains the 40 items of the original scale. Internal consistency proved to be high, with a Cronbach's alpha coefficient of 0.95 for the total scale. Content validity was ensured during the initial stages of the translation and cross-cultural adaptation process. Construct validity was analysed using factor analysis, which identified the four leadership dimensions assessed, explaining 49.39% of the total variance: Critical and Strategic Thinking; Teamwork Skills; Emotional Intelligence; and Communication and Relational Influence. The final factor model achieved showed very good fit indices, which reinforced the underlying theoretical structure.

Conclusion: The PT-SALI proved to be a valid, reliable, and robust tool for assessing, monitoring, and promoting the development of leadership competences in the Portuguese cultural context, with applicability in undergraduate and postgraduate contexts.

Background: Understanding how healthcare professionals conceptualize leadership is vital for developing effective leadership development programs in medical universities. However, little is known about Implicit Leadership Theories (ILTs) within the unique context of Iranian medical universities, where education and healthcare service provision intersect.

Aim: This study explored implicit leadership expectations among faculty and staff in a medical university setting, emphasizing the novelty of examining ILTs in Iran's academic health system and its potential relevance for similar institutions globally.

Methods: A qualitative phenomenological approach was employed to investigate ILTs among faculty and managers at Khomein University of Medical Sciences, a regional institution integrating healthcare services with clinical education. Fifteen participants were purposively sampled and interviewed using a semi-structured guide, drawn from twenty invited individuals. Data were analyzed using Colaizzi's method with support from MAXQDA. Ethical approval was obtained, and informed consent was secured from all participants.

Results: Four domains of ILTs were identified: (1) ethical and personal traits such as honesty, justice, and humility; (2) managerial and organizational competencies and capabilities, including planning, decision-making, and accountability; (3) communication and relational behaviors emphasizing respect, empathy, and participation; and (4) structural and cultural conditions shaping leader effectiveness.

Conclusion: Findings highlight the need to align leadership behaviors with follower expectations to foster trust, strengthen leadership development, and enhance institutional performance. Situating ILTs in a non-Western academic health setting expands the global literature on leadership and followership, offering insights for medical universities in Iran and comparable systems internationally.

Background: Operating room (OR) nurses frequently experience work-related musculoskeletal disorders (MSDs) and psychological strain due to prolonged static postures, repetitive movements, and high-stress conditions. While short-term benefits of microbreak interventions have been demonstrated, evidence on their long-term effectiveness and impact on patient safety remains limited. This study aimed to evaluate the sustained effects of structured microbreaks on MSD outcomes, psychological wellbeing, and patient safety, and to explore organizational factors influencing intervention adherence.

Methods: A nonrandomized, controlled, multicenter mixed‑methods study, six-month follow‑up (N = 178 analyzed) was conducted in five hospitals in Shanxi Province, China. Ninety-one OR nurses received a structured microbreak intervention (2-3-minute breaks every 30 minutes during procedures >60 minutes, including ergonomic exercises and mindfulness practices), while 87 served as controls (analyzed cohorts after attrition). Quantitative data (Nordic Musculoskeletal Questionnaire, Perceived Stress Scale, Maslach Burnout Inventory, patient safety metrics) were collected at baseline and six months. Qualitative data were gathered through semi-structured focus groups and interviews with intervention participants.

Results: Compared to controls, intervention nurses experienced significantly greater reductions in MSD prevalence (-20.9 vs -5.7 percentage points, p < 0.01) and pain intensity (p < 0.001), alongside marked improvements in perceived stress (-4.4 vs -0.6 points, p < 0.001) and burnout dimensions (emotional exhaustion: -6.3 vs -0.8 points, p < 0.001). Improvements in patient safety metrics were also observed, with larger reductions in medication errors (-7.4% vs -2.5%) and surgical site infections (-5.2% vs -1.6%), and increased patient satisfaction scores (+1.5 vs +0.5 points, p < 0.01). Qualitative findings highlighted leadership engagement, clear protocols, and cultural integration as key facilitators, while emergency cases and staff shortages posed barriers. Adaptive strategies, such as flexible scheduling, supported sustained implementation.

Conclusion: Structured microbreaks yielded sustained improvements in MSD outcomes, psychological wellbeing, and patient safety, with organizational support and adaptability proving crucial for long-term success. Integrating microbreaks into routine OR workflows may enhance nurse health, reduce errors, and improve patient care quality, offering a strategic, resource-feasible intervention for high-stress healthcare settings. Findings support embedding microbreaks into standard operating procedures and orientation, using leadership role‑modeling, brief "buddy" coverage, and lightweight prompts to optimize fidelity at scale.

Introduction: Leadership is a critical competency in healthcare, influencing patient outcomes, organizational performance, and interprofessional collaboration. The study aimed to explore the behavioral determinants of leadership engagement among health profession students, and to examine associations with sociodemographic characteristics and leadership experience.

Methods: A cross-sectional survey was administrated to health profession students at Qatar University health sector (n= 225). The survey was developed using the Theoretical Domains Framework (TDF) and analyzed using principal component analysis (PCA) to identify key behavioral components. Ordinal regression was used to assess associations between the components and sociodemographic factors, including nationality, college affiliation, and prior and current leadership experience.

Results: PCA identified four behavioral determinants of leadership: 1) intention and self-efficacy, 2) awareness of opportunities, 3) perceived benefits, and outcomes, and 4) perceived barriers, each demonstrating acceptable internal consistency. Regression analysis confirmed significant predictive power across these determinants, with factors such as college affiliation, nationality, and prior leadership experience influencing outcomes. Approximately 25% of students reported holding leadership roles, yet more than half of these student leaders had no formal leadership training.

Discussion: Findings highlight the importance of integrating structured leadership training and increasing access to leadership opportunities in a diverse, interprofessional student population. Initiatives such as interprofessional education student associations provide a valuable platform for fostering leadership skills in collaborative settings. These findings can inform the design of targeted educational interventions that support the development of essential leadership skills and cultivate the next generation of health leaders.

Introduction: Australia's health system is strong, but fragmented across primary, secondary, and tertiary care. Primary Health Networks (PHNs) were established to streamline non-hospital-based health services and improve service effectiveness and efficiency across Australia, which can be achieved by fostering strong relationships with providers to build commissioning capabilities. Successful commissioning depends on the providers' ability to respond to commissioning opportunities.

Objective: This study aimed to identify capability development opportunities that support service provider organisations commissioned by PHN to deliver effective and efficient services in primary care.

Methods: A mixed-method case study approach was used, including an anonymous online survey and a focus group discussion.

Results: The study confirmed the key factors for health commissioning success in the following four dimensions: workforce development, effective engagement, support and guidance, and strong relationships. The study further recommends seven key strategies for capability development, highlighting the need for PHNs to focus on building the capability of primary care organisations to establish strong markets and successfully commission services.

Discussion: Building strong relationships through effective engagement that features support and guidance for service provider organisations is critical for PHNs' commissioning success. All organisations must work collaboratively and fully appreciate the unique limitations constraining PHNs that impact community needs and health outcomes. Given the variations in the size and function of commissioned service providers, factors such as locally developed service models, program differences, and regional needs should be considered when planning specific capability building activities.

Conclusion: Understanding the challenges faced by provider organisations to support commissioning capability development is imperative for PHNs to successfully commission health and social care services. Identifying key actions to support capability development while building strong relationships and learning from the insights produced by this study will enhance service co-design and collectively strengthen the market's ability to meet the growing health needs of local communities.

Background: The psychosocial work environment in healthcare is widely recognized as challenging. High workload, stress, and poor work-life balance contribute to negative health outcomes for healthcare workers. Swedish primary healthcare faces similar issues, yet efforts to address them have focused primarily on individual-based interventions, such as stress management. Research on organizational initiatives remains limited, despite their greater potential for achieving long-term, sustainable improvements.

Aim: This study aims to explore characteristics of primary healthcare units where organizational initiatives to improve the psychosocial work environment have been successfully carried out.

Methods: A multiple case approach was used, allowing various cases to be investigated and enabling identification of similarities and common patterns across the units.

Results: Four main categories and 16 subcategories were identified, capturing key factors that contribute to a favorable psychosocial work environment in primary healthcare through organizational initiatives. The main categories are engaged leadership, an open workplace climate, conditions for improvement, and a structured work organization.

Conclusion: This study identifies key characteristics of primary healthcare units that contribute to creating a favorable psychosocial work environment in Swedish primary healthcare. These elements promote inclusivity, balanced change processes, and staff involvement in decision-making. The findings underscore the need for further research on managerial challenges and effective strategies for staff recruitment and retention.

Purpose: Healthcare commissioning is crucial for addressing the increasing demands of the patient population while reducing maintenance and management costs. However, commissioning committee members can encounter several challenges. Therefore, this study comprehensively examined the experiences of members of the Commissioning Final Readiness Committee involved in commissioning the Women's Health Hospital in Riyadh, Saudi Arabia.

Methods: An exploratory qualitative design was used, utilizing semi-structured interviews guided by Gibbs's reflective cycle. A sample of 11 participants representing diverse healthcare professions was included to capture a broad spectrum of insights. The interviews were conducted within a supportive and anonymous framework, adhering rigorously to the ethical standards established by the King Abdullah International Research Center and Ministry of National Guard Health Affairs.

Results: The findings revealed three main themes: (i) the role of the Commissioning Final Readiness Committee members, (ii) the reflective experiences of the Commissioning Final Readiness Committee members, and (iii) the recommendations of the Commissioning Final Readiness Committee members. These advancements were primarily attributed to the effective communication and collaboration among members.

Conclusion: Although the task complexities posed certain challenges, the participants viewed them as valuable learning experiences that contributed to their growth. The Commissioning Final Readiness Committee can significantly impact the commissioning process. Despite encountering uncontrollable factors, maintaining a cohesive team allows members to effectively navigate these difficulties and achieve professional growth.