Journal of Health Organization and Management最新文献

Purpose: This study aimed to investigate the impact of emerging digital health technologies on the sustainability of primary healthcare systems in Tanzania, focusing on operational, institutional, social and environmental dimensions.

Design/methodology/approach: A convergent mixed-methods design was employed in Tanzania. Quantitative data were collected from 240 healthcare workers across 204 primary healthcare facilities using a structured questionnaire. Regression analysis identified predictors of sustainability outcomes based on the technology-organisation-environment (TOE) framework. In parallel, qualitative data were gathered through 25 semi-structured interviews with health professionals and administrators. Thematic analysis was employed to explore perceptions, experiences and institutional challenges associated with digital health implementation.

Findings: Usability, system reliability and staff capacity were significant predictors of operational sustainability (R2 = 0.760), while training availability, leadership support and policy support were strong predictors of institutional sustainability (R2 = 0.844). Environmental sustainability received the lowest overall rating (mean = 2.41, SD = 0.78), reflecting constraints such as unstable electricity, limited funding and a lack of maintenance planning. Qualitative findings reinforced these patterns, with participants reporting improved workflow and data visibility but raising concerns about digital exclusion, weak governance and inequities between urban and rural facilities. The integration of findings highlighted the need for coordinated investments beyond infrastructure, including sustained training, policy coherence and targeted support for under-resourced health centres.

Originality/value: This study extends the TOE framework to a multi-dimensional sustainability context, integrating operational, institutional, social and environmental perspectives in a low-resource primary healthcare setting. It provides evidence that sustainable digital health implementation requires not only technological functionality but also organisational readiness, inclusive policies and attention to environmental resilience.

Purpose: We explore what happens to home-based healthcare practice 11 years after implementing a healthcare reform, the Coordination Reform in 2012.

Design/methodology/approach: We conducted a qualitative study using document analysis and five focus group interviews with 27 department leaders in home-based healthcare practices in 2023. An inductive thematic analysis was conducted.

Findings: Our qualitative design sheds light on how macro-ideas, reforms, and policies shape practice across healthcare institutions and the challenges they face. It highlights that reforms, often driven by efficiency goals, rarely lead to swift changes due to resistance rooted in established norms, values and practices. Still eleven years post-reform, we observe minimal progress in cross-level clinical coordination. The study identifies key barriers, including issues with information flow, trust and collaboration between hospitals and municipal healthcare services. Additionally, it examines the role of path dependency, explaining the persistence of prior routines despite reforms and provides a theoretical lens for understanding resistance to change in healthcare.

Practical implications: By applying institutional theory to healthcare reforms, policymakers and practitioners can better navigate the complex forces shaping healthcare policy.

Originality/value: Our findings illustrate how macro-ideas and policies are diffused across institutional levels in the municipality healthcare sector and how organizational actors and their immediate context shape practice when it comes to cross-clinical coordination.

Purpose: Drawing on social exchange theory (SET) and social identity theory (SIT), this study investigates how the high-performance work systems (HPWS)-turnover intention () link is mediated by organizational identification (OID) and moderated by trust in leader (TIL) and perceived organizational support (POS).

Design/methodology/approach: A two-wave time-lagged survey research was conducted on healthcare professionals in Nigeria, comprising medical doctors, nurses and midwives, and 387 valid responses were received.

Findings: The results indicated that HPWS significantly and negatively predicted TI and significantly and positively predicted OID. In turn, OID significantly and negatively predicted TI. OID partially mediated the relationship between HPWS and TI. While the moderating effect of TIL on the relationship between HPWS and OID was not significant, POS was found to significantly strengthen the negative relationship between OID and TI.

Originality/value: Despite a considerable body of research on the outcomes of HPWS, its underlying mechanisms and boundary conditions remain elusive. This study therefore offers valuable theoretical contributions to advancing the literature on how and when HPWS influence employee outcomes.

Purpose: To determine the relationship between nursing care satisfaction levels and nursing image perceptions of patients hospitalized in inpatient units of a university hospital.

Design/methodology/approach: This is a descriptive, correlational and cross-sectional study. The study data were collected from 610 patients hospitalized in the inpatient units of a university hospital with the Introductory Information Form, Patient Perception of Hospital Experience with Nursing Care and the Nursing Image Scale. Descriptive analyses, independent groups t-test, one-way analysis of variance, Mann-Whitney U test, Kruskal-Wallis test and Spearman correlation analysis were employed in the analysis of the data.

Findings: It was determined that the Nursing Image Scale scores differed statistically significantly according to the participants' age, education level, state of thinking that they received quality nursing care and nursing image perception of the participants. It can be stated that the satisfaction of the patients participating in the study with the nursing care provided is high, and the nursing image they perceive is at a high level and positive. A positive and significant relationship was found between the participants' nursing care satisfaction levels and their perceptions of nursing image (r = 0.502, p < 0.01).

Originality/value: The results of the study are very important in terms of showing the effect of the image of nursing not only in terms of the development of the profession but also on the perception of the care provided. It is recommended that health institutions and managers determine more strategies in this regard because it affects the preferability of their institutions and the satisfaction of the care provided.

Purpose: This study aimed to determine the mediating effect of team job crafting in the relationship between sparking leadership and work engagement and establish a model.

Design/methodology/approach: This descriptive and correlational study included 400 nurses selected through convenience sampling. Data were collected using the Sparking Leadership Scale, Work Engagement Scale, and Team Job Crafting Scale, and analyzed with IBM SPSS and AMOS. The STROBE guideline was followed in reporting the study.

Findings: The conceptual model hypothesized, which included latent and observed variables, was a good fit to the data. The factor loadings of all observed variables were between 0.73 and 0.91 and significant. According to these findings, the latent variables were well represented. Sparking leadership had a direct positive effect on team job crafting (β = 0.792), and team job crafting had a direct positive effect on work engagement (β = 0.390). The direct effect of sparking leadership on work engagement was insignificant (β = 0.186), but its indirect positive effect through team job crafting was significant (β = 0.309). According to the results of the study, team job crafting was found to fully mediate the relationship between sparking leadership and work engagement.

Originality/value: The results of the study are very important in terms of showing the sparking leadership enhances nurses' work engagement indirectly by promoting team job crafting. These findings underscore the importance of leadership and teamwork in fostering engagement in healthcare settings. It is recomended that nurse managers' leadership approaches should be evaluated, and structured strategies should be developed to enhance sparking leadership skills. Educational programs and workshops will support the adoption of this style, fostering team job crafting, work engagement, and a sustainable leadership culture in nursing.

Purpose: This article studies the customer's purchase intention to choose healthcare services in the post-COVID-19 situation. The authors have used the most prominent SERVQUAL model to assess the service quality offered to patients and each variable's influence on customer intent to purchase healthcare services.

Design/methodology/approach: Tangibility, reliability, responsiveness, assurance, empathy, hospital image and customer purchase intention are the variables considered for this study. Data have been collected from customers who have recently experienced services in different hospitals. Standardized statements of the SERVQUAL model and purchase intention were adapted and modified as per the requirements of the constructs. Out of 271 filled questionnaires, the authors have undertaken the data cleaning process to circumvent any kind of biasness; finally the authors have considered 225 questionnaires to conduct this research work.

Findings: This study's findings indicate significant and positive relationships between service quality, hospital image and customer purchase intention to choose hospital services. Additionally, the mediating role of hospital image was confirmed in all four hypotheses.

Practical implications: The results of this study provide practitioners with valuable insights and guidance for developing effective strategies for providing better services to patients.

Originality/value: Confirmatory factor analysis (CFA) was used to check the validity and reliability of all the constructs. Due to the high correlation between tangibility, reliability, responsiveness, assurance and empathy, authors have created a second-order construct, i.e. service quality. Authors have also used structural equation modeling (SEM) to inspect the associations between different constructs. Authors have measured the mediating role of hospital image between the relationship of all the service quality dimensions and customer purchase intention.

Purpose: This study aims to evaluate the effects of perceived leader--member exchange and working conditions on turnover intention among healthcare employees.

Design/methodology/approach: The study population consisted of healthcare employees working in a medical faculty hospital in Türkiye. A stratified sampling method was used in sample selection. The data were obtained by the questionnaire method, and voluntary participation was taken as a basis. The questionnaire included sociodemographic information, a leader--member exchange (LMX) scale and a turnover intention scale. The research was conducted between April and May 2022 and completed with 400 participants. Descriptive statistics, correlation analysis and multiple linear stepwise regression analyses were chosen for data analysis.

Findings: The findings showed that the participants had a medium-level perception of leader--member exchange and a medium-level turnover intention. Multiple linear stepwise regression analysis revealed that especially "affect and professional respect" sub-dimensions of LMX had a statistically significant and negative effect on turnover intention scores. In addition, weekly working hours had a statistically significant and positive effect on turnover intention (p < 0.05). Finally, it was determined that the variance in turnover intention score was explained by the "affect and professional respect" sub-dimensions of LMX and weekly working hours (R2 = 0.241).

Originality/value: This study provides evidence on the impact of the "affect" and "professional respect" sub-dimensions of leader-member exchange as well as work environment factors on the turnover intentions of healthcare employees. The results are expected to guide healthcare organization leaders and managers on how to create a collaborative work environment that leads to employee retention.

Purpose: This study examines work ability, defined as the balance between personal resources and job demands. It is considered a key indicator of sustainable employability, a critical issue in the healthcare context. Specifically, it analyzes how job resources and demands shape employees' work ability and evaluates the role of work-life balance as a potential mediator of these relationships.

Design/methodology/approach: We estimate structural equation modeling (SEM) using STATA 18 on a sample of 443 healthcare workers at the University Hospital of Modena (Italy).

Findings: Our findings show that supportive supervisors, work autonomy and discretion positively influence work ability. Work-life balance emerges as a crucial mediator of the relationships between work autonomy, work intensification and employee work ability.

Practical implications: These results underscore the crucial role of organizational practices in bolstering work ability and well-being. Key priorities include enhancing leadership quality through training and mentoring initiatives. Equally important is fostering work-life balance by enhancing employee autonomy and involvement in key decisions related to their work.

Originality/value: This paper contributes to the literature by providing an in-depth analysis of job demands and resources affecting work ability in the healthcare sector. Furthermore, it is the first study to evaluate the mediating role of work-life balance in this specific context.

Purpose: Healthcare has been facing rising challenges in recent years. To mitigate these issues, an appreciable amount of effort has been invested in studies about Healthcare 4.0. Despite the recognized importance of this topic, its recentness and multidisciplinary character are obstacles to its precise understanding. In this light, this paper aims to provide a comprehensive view of the current development of Healthcare 4.0.

Design/methodology/approach: We systematically reviewed the literature, which resulted in 130 papers retrieved from the Web of Science and Scopus databases. Quantitative and qualitative analyses were carried out using this sample.

Findings: As a result of the quantitative analysis, we notice an increasing trend in health-related studies, notwithstanding its novelty. India is also recognized as the leading reference on the subject, as it is the country with more papers in the sample and the most influential authors. On the other hand, through qualitative analysis, an extensive review and analysis of the technologies and applications of Healthcare 4.0 is presented, along with a discussion of its underexplored areas.

Originality/value: The results of this paper provide valuable knowledge to guide and encourage further analysis on this topic, including recommendations for future research directions.

Purpose: The conclusion of the COVID-19 pandemic provides an opportune moment to assess the performance of health systems in financial protection. This study aims to analyze the state of financial protection within Iran's healthcare system during the COVID-19 pandemic and propose practical solutions to enhance the system's financial protection.

Design/methodology/approach: This study, conducted in three stages, first assessed financial protection among 24,170 COVID-19 patients in three major Tehran hospitals, categorized by insurance status. We used dispersion indices to depict cost distribution and the Kruskal-Wallis test to analyze variations in out-of-pocket payments. In the second phase, ordinary least squares regression identified key factors affecting out-of-pocket payments. The third stage involved deriving strategies to improve health system financial protection using the Delphi technique and prioritizing them with the TOPSIS approach.

Findings: The average patient hospitalization cost was 512.41 US$, with patients covering 29.60% of total expenses while insurers handled 70.39%. Among Iran's basic health insurances, armed forces insurance exhibited the highest financial protection, with over 90% for insurers and less than 10% for the insured. The study highlights the significance of factors like prevention, equitable access, healthcare cost structuring and economic efficiency in enhancing financial protection. Priority for strengthening financial protection is given to promoting disease prevention and structuring demand through family doctor mechanisms and referral systems.

Originality/value: Enhancing financial protection requires attention to a wide range of measures, including health promotion and prevention, organizing healthcare demand, improving access structures, leveraging technological advancements and optimizing economic efficiency within the healthcare system.