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Healthcare providers are under pressure due to increasing and more complex demands for services. Increased pressure on budgets and human resources adds to an ever-growing problem set. Competent leaders are in demand to ensure effective and well-performing healthcare organisations that deliver balanced results and high-quality services. Researchers have made significant efforts to identify and define determining competencies for healthcare leadership. Broad terms such as competence are, however, inherently at risk of becoming too generic to add analytical value. The purpose of this study is to suggest a holistic framework for understanding healthcare leadership competence, that can be crucial for operationalising important healthcare leadership competencies for researchers, decision-makers as well as practitioners.

In the present study, a critical interpretive synthesis (CIS) was conducted to analyse competency descriptions for healthcare leaders. The descriptions were retrieved from peer reviewed empirical studies published between 2010 and 2022 that aimed to identify healthcare services leadership competencies. Grounded theory was utilised to code the data and inductively develop new categories of healthcare leadership competencies. The categorisation was then analysed to suggest a holistic framework for healthcare leadership competence.

Forty-one papers were included in the review. Coding and analysing the competence descriptions resulted in 12 healthcare leadership competence categories: (1) character, (2) interpersonal relations, (3) leadership, (4) professionalism, (5) soft HRM, (6) management, (7) organisational knowledge, (8) technology, (9) knowledge of the healthcare environment, (10) change and innovation, (11) knowledge transformation and (12) boundary spanning. Based on this result, a holistic framework for understanding and analysing healthcare services leadership competencies was suggested. This framework suggests that the 12 categories of healthcare leadership competencies include a range of knowledge, skills and abilities that can be understood across the dimension personal – and technical, and organisational internal and – external competencies.

This literature review was conducted with the results of searching only two electronic databases. Because of this, there is a chance that there exist empirical studies that could have added to the development of the competence categories or could have contradicted some of the descriptions used in this analysis that were assessed as quite harmonised. A CIS also opens for a broader search, including the grey literature, books, policy documents and so on, but this study was limited to peer-reviewed empirical studies. This limitation could also have affected the result, as complex phenomenon such as competence might have been disclosed in greater details in, for example, books.

The holistic framework for healthcare leadership competences offers a common understanding of a “fuzzy” concept such as competence and can be used to identify specific competency needs in healthcare organisations, to develop strategic competency plans and educational programmes for healthcare leaders.

This study reveals a lack of consensus regarding the use and understanding of the concept of competence, and that key competencies addressed in the included papers are described vastly different in terms of what knowledge, skills and abilities they entail. This challenges the operationalisation of healthcare services leadership competencies. The proposed framework for healthcare services leadership competencies offers a common understanding of work-related competencies and a possibility to analyse key leadership competencies based on a holistic framework.

The purpose of this mixed-methods study was to explore how medical secretaries experience digital transformation in a Swedish healthcare organisation, with a focus on workplace climate and health.

Data were collected using a sequential exploratory mixed-methods design based on grounded theory, with qualitative data collection (a Quality Café and individual interviews) followed by quantitative data collection (a questionnaire).

Four categories with seven underlying factors were identified, emphasising the crucial need for effective organisation of digital transformation. This is vital due to the increased knowledge and skills in utilising technology. The evolving roles and responsibilities of medical secretaries in dynamic healthcare settings should be clearly defined and acknowledged, highlighting the importance of professionality. Ensuring proper training for medical secretaries and other occupations in emerging techniques is crucial, emphasising equal value and knowledge across each role. Associations were found between some factors and the health of medical secretaries.

This study adds to the knowledge on digital transformation in healthcare by examining an important occupation. Most data were collected online, which may be a limitation of this study.

Several aspects of the medical secretaries’ experiences were identified. Knowledge of these is valuable for healthcare managers to make digital transformation more effective while avoiding excessive strain on medical secretaries.

Medical secretaries are expected to contribute to the digitalisation of healthcare. However, minimal research has been conducted on the role of medical secretaries in workplace digitalisation, focusing on workplace roles and its dynamics.

As part of a national plan to govern professional and organizational development in Norwegian specialist healthcare, the country’s hospital clinics are tasked with constructing development plans. Using the development plan as a case, the paper analyzes how managers navigate and legitimize the planning process among central actors and deals with the contingency of decisions in such strategy work.

This study applies a qualitative research design using a case study method. The material consists of public documents, observations and single interviews, covering the process of constructing a development plan at the clinical level.

The findings suggest that the development plan was shaped through a multilevel translation process consisting of different contending rationalities. At the clinical level, the management had difficulties in legitimizing the process. The underlying tension between top-down and bottom-up steering challenged involvement and made it difficult to manage the contingency of decisions.

The findings are relevant to public sector managers working on strategy documents and policymakers identifying challenges that might hinder the fulfillment of political intentions.

This paper draws on a case from Norway; however, the findings are of general interest. The study contributes to the academic discussion on how to consider both the health authorities’ perspective and the organizational perspective to understand the manager’s role in handling the contingency of decisions and managing paradoxes in the decision-making process.

Further investigation is needed of network effectiveness in healthcare and how it is influenced by unpredictable events like COVID-19. Based on Provan and Milward’s (2001) framework, this study investigates the effectiveness criteria of healthcare networks and their potential contribution to network effectiveness during the pandemic’s challenges.

This research employs an explanatory case study in a local area of Italy’s Lombardy Region and analyzes network effectiveness at the network level based on network member perceptions.

Network effectiveness refers to the network’s ability to address patient needs, guaranteeing services through network members' coordinated efforts and a central coordinator that facilitates their interaction. Members’ capacity to strengthen their roles played a crucial part in sustaining network effectiveness when COVID-19 revised other members’ priorities and threatened achievement of network goals.

This study’s findings equip healthcare managers and policymakers with knowledge about network effectiveness criteria at the network level, offering suggestions for managerial practices and network design to address exogenous shocks.

This study identifies factors that influence network effectiveness criteria and provides insight into how network members can contribute to sustaining effectiveness during crises.

During the 1990s, Italian healthcare organisations (HOs) underwent a process of corporatisation, and the most innovative HOs introduced the balanced scorecard (BSC) to address the need for broader accountability. Currently, there is a limited understanding of the dynamics and outcomes of such a process. Therefore, this study aims to explore whether the BSC is still considered an effective performance management tool and analyse the factors driving and hindering its evolution and endurance in public and non-profit HOs.

We conducted a retrospective longitudinal analysis of two pioneering cases in the adoption of the BSC: one in a public hospital and the other in a non-profit hospital. Data collection relied on accessing institutional documents and reports from the early 2000s to the present, as well as conducting semi-structured interviews with the internal sponsors of the BSC.

We found evidence of three main categories of factors that trigger or hinder the adoption and development of the BSC: (1) the role of the internal sponsor and professionals’ commitment; (2) information technology and the controller’s technological skills; and (3) the relationship between the management and professionalism logics during the implementation process. At the same time, there is no evidence to suggest that specific technical features of the BSC influence its endurance.

The paper contributes to the debate on the key factors for implementing and sustaining multidimensional control systems in professional organisations. It emphasises the importance of knowledge-based assets and distinctive internal capabilities for the success of the business. The implications of the BSC legacy are discussed, along with future developments of multidimensional control tools aimed at supporting strategy execution.

This literature review aims to assess the current research on healthcare job availability and skilled professionals. The objective of this research is to identify challenges caused by the imbalance between healthcare service demand and qualified professionals and propose potential solutions and future research directions.

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method was employed as the guiding framework for conducting this review. A qualitative research design analyzed 38 peer-reviewed, evidence-based research works from 50 journal publications. Inclusion criteria focused on empirical studies, observational research and comprehensive reviews published within the last ten years. Thematic and discourse analysis categorized themes and factors explored in selected publications.

The findings highlight significant challenges in the healthcare sector regarding job availability and skilled professionals. Developed countries face understaffed healthcare facilities, resulting in increased workloads and compromised care. Developing countries experience high rates of unemployment among healthcare graduates due to limited resources and mentorship.

Improving educational infrastructure, expanding training opportunities and increasing healthcare investments are crucial for nurturing a skilled workforce. Implementing effective retention policies, fostering international collaborations and addressing socioeconomic determinants can create a sustainable job market.

The healthcare sector faces critical challenges in balancing job availability and skilled professionals. Strategic solutions are proposed to create a sustainable and equitable healthcare workforce. By implementing recommendations and conducting further research, access to quality healthcare and global public health outcomes can be improved.

The paper aims to investigate the practices facilitating the transformation of healthcare services, understanding the resulting outcomes in terms of well-being and uplifting changes. a systematic literature review (SLR) focusing on analyzing the healthcare sector under the transformative service research (TSR) theoretical domain is conducted to achieve this goal.

Employing a structured SLR developed based on the PRISMA protocol (Pickering and Byrne, 2014; Pickering et al., 2015) and using Scopus and WoS databases, the study identifies and analyzes 49 papers published between 2021 and 2022. Content analysis is used to classify and analyze the papers.

The SLR reveals four transformative practices (how) within the healthcare sector under the TSR domain, each linked to specific well-being outcomes (what). The analysis shows that both practices and outcomes are mainly patient-related. An integrative framework for transformative healthcare service is presented and critically examined to identify research gaps and define the trajectory for the future development of TSR in healthcare. In addition, managerial implications are provided to guide practitioners.

This research is among the first to analyze TSR literature in the context of healthcare. The study critically examines the TSR’s impact on the sector’s transformation, providing insights for future research and offering a roadmap for healthcare practitioners to facilitate uplifting changes.

Value-based healthcare suggested using patient-reported information to complement the information available in the medical records and administrative healthcare data to provide insights into patients' perceptions of satisfaction, experience and self-reported outcomes. However, little attention has been devoted to questions about factors fostering the use of patient-reported information to create value at the system level.

Action research design is carried out to elicit possible triggers using the case of patient-reported experience and outcome data for breast cancer women along their clinical pathway in the clinical breast network of Tuscany (Italy).

The case shows that communication and engagement of multi-stakeholder representation are needed for making information actionable in a multi-level, multispecialty care pathway organized in a clinical network; moreover, political and managerial support from higher level governance is a stimulus for legitimizing the use for quality improvement. At the organizational level, an external facilitator disclosing and discussing real-world uses of collected data is a trigger to link measures to action. Also, clinical champion(s) and clear goals are key success factors. Nonetheless, resource munificent and dedicated information support tools together with education and learning routines are enabling factors.

Current literature focuses on key factors that impact performance information use often considering unidimensional performance and internal sources of information. The use of patient/user-reported information is not yet well-studied especially in supporting quality improvement in multi-stakeholder governance. The work appears relevant for the implications it carries, especially for policymakers and public sector managers when confronting the gap in patient-reported measures for quality improvement.

The primary objective of this paper is to show a systematic and methodological approach for the digitalization of critical clinical pathways (CPs) within the healthcare domain.

The methodology entails the integration of service design (SD) and action research (AR) methodologies, characterized by iterative phases that systematically alternate between action and reflective processes, fostering cycles of change and learning. Within this framework, stakeholders are engaged through semi-structured interviews, while the existing and envisioned processes are delineated and represented using BPMN 2.0. These methodological steps emphasize the development of an autonomous, patient-centric web application alongside the implementation of an adaptable and patient-oriented scheduling system. Also, business processes simulation is employed to measure key performance indicators of processes and test for potential improvements. This method is implemented in the context of the CP addressing transient loss of consciousness (TLOC), within a publicly funded hospital setting.

The methodology integrating SD and AR enables the detection of pivotal bottlenecks within diagnostic CPs and proposes optimal corrective measures to ensure uninterrupted patient care, all the while advancing the digitalization of diagnostic CP management. This study contributes to theoretical discussions by emphasizing the criticality of process optimization, the transformative potential of digitalization in healthcare and the paramount importance of user-centric design principles, and offers valuable insights into healthcare management implications.

The study’s relevance lies in its ability to enhance healthcare practices without necessitating disruptive and resource-intensive process overhauls. This pragmatic approach aligns with the imperative for healthcare organizations to improve their operations efficiently and cost-effectively, making the study’s findings relevant.

Despite the unparalleled importance of value within healthcare, value-based models remain underutilised in the procurement of medical devices. Research is needed to understand what factors incentivise standard, low-priced device purchasing as opposed to value-adding devices with potentially higher overall health outcomes. Framed in agency theory, we examine the conditions under which different actors involved in purchasing decisions select premium-priced, value-adding medical devices over low-priced, standard medical devices.

We conducted 2 × 2 × 2 between-subjects scenario-based vignette experiments on three UK-based online samples of managers (n = 599), medical professionals (n = 279) and purchasing managers (n = 449) with subjects randomly assigned to three treatments: (1) cost-saving incentives, (2) risk-sharing contracts and (3) stronger (versus weaker) clinical evidence.

Our analysis demonstrates the harmful effects of intra-organisational cost-saving incentives on value-based purchasing (VBP) adoption; the positive impact of inter-organisational risk-sharing contracts, especially when medical professionals are involved in decision-making; and the challenge of leveraging clinical evidence to support value claims.

Our results demonstrate the need to align incentives in a context with multiple intra- and inter-organisational agency relationships at play, as well as the difficulty of reducing information asymmetry when information is not easily interpretable to all decision-makers. Overall, the intra-organisational agency factors strongly influenced the choices for the inter-organisational agency relationship.

We contribute to VBP in healthcare by examining the role of intra- and inter-organisational agency relationships and incentives concerning VBP (non-) adoption. We also examine how the impact of such mechanisms differs between medical and purchasing (management) professionals.