Search Results (343)

Background: Patient safety culture is critical for enhancing the quality and safety of healthcare. Studies in low- and middle-income countries have reported challenges in developing patient safety culture, especially in implementing nonpunitive responses to errors and event reporting. However, evidence from Laos remains limited. Objectives: This study aimed to assess patient safety culture in hospitals in southern Laos, using a validated survey tool to identify strengths and areas of improvement. Methods: A cross-sectional study using purposive sampling was conducted in four provincial and twenty-three district hospitals in southern Laos. Healthcare workers on patient safety committees responded to the Hospital Survey on Patient Safety Culture. The positive response rate was analyzed. Bivariate tests (chi-square/Fisher’s exact) were applied to compare positive response rates between hospital types and professions. Results: A total of 253 valid responses (75.5%) were analyzed. “Organizational Learning–Continuous Improvement” scored over 75% in both provincial and district hospitals. In contrast, “Nonpunitive Response to Error” and “Frequency of Events Reported” were scored <20% on average. Provincial hospitals scored significantly higher than district hospitals in supervisory support and handoffs. Conclusions: This study illustrated strengths in organizational learning while identifying nonpunitive responses and event reporting as critical areas of improvement for hospitals in Laos. To improve patient safety, hospitals in Laos must promote a culture in which errors can be reported without fear of blame. Strengthening leadership support and reporting systems is essential. These findings can inform strategies to enhance patient safety in other low-resource healthcare settings. Full article

Background: Digital platforms and inclusive leadership are pivotal in modern healthcare, influencing organizational performance and patient outcomes. Despite the growing adoption of these factors, their combined impact on leadership effectiveness and patient care remains insufficiently understood. Prior research has primarily examined digital technology or leadership inclusivity separately, lacking integrative studies that address their joint effect on healthcare outcomes. There is a need to explore how these variables interact to improve leadership and patient-related metrics. Methods: This cross-sectional study surveyed 250 participants, including healthcare leaders, professionals, and patients, using structured questionnaires. The data analysis involved multiple regression, structural equation modeling (SEM), and hierarchical linear modeling (HLM) to examine the direct and hierarchical relationships among digital platform usage, leadership inclusivity, leadership effectiveness, and patient outcomes. Results: Leadership inclusivity showed a significant positive effect on leadership effectiveness (β = 0.16, p < 0.01) and patient satisfaction (β = 0.09, p < 0.05). Digital platform usage demonstrated a smaller but positive association with leadership effectiveness (β = 0.04) and patient satisfaction (β = 0.03). Leadership effectiveness was found to correlate moderately with patient safety (β = 0.23) and treatment efficacy (β = 0.25), with minimal organizational-level effects. Conclusions: This study uniquely integrates the adoption of digital technology with inclusive leadership, highlighting their synergistic influence on healthcare delivery. It advances the existing literature by providing quantitative evidence on how these elements interact to shape leadership and patient care outcomes. Full article

Introduction: Work life quality (WLQ) in nursing is a critical factor that influences both staff well-being and the quality of care provided to patients. Spiritual intelligence (SI) and servant leadership (SL) have been identified as potential positive predictors of WLQ, as they facilitate resilience, job satisfaction, and stress management in highly demanding hospital environments. However, the specific relationship between these constructs in the Peruvian nursing context has not yet been thoroughly explored. Objective: We aimed to examine the impact of spiritual intelligence and servant leadership on the work life quality of Peruvian nurses, assessing their predictive role through a structural equation modeling approach. Methods: A cross-sectional and explanatory study was conducted with a sample of 134 Peruvian nurses (M = 36.29 years, SD = 7.3). Validated Spanish-language instruments were used to measure SI, SL, and WLQ. Structural equation modeling (SEM) with a robust maximum likelihood estimator (MLR) was employed to evaluate the relationships between the variables. Results: Spiritual intelligence showed a positive correlation with WLQ (r = 0.40, p < 0.01) and with servant leadership (r = 0.44, p < 0.01). Likewise, servant leadership had a significant relationship with WLQ (r = 0.53, p < 0.01). The structural model demonstrated a good fit (χ² = 1314.240, df = 970, CFI = 0.96, TLI = 0.96, RMSEA = 0.05, SRMR = 0.08). The hypothesis that SI positively predicts WLQ was confirmed (β = 0.41, p < 0.001), as was the significant effect of SL on WLQ (β = 0.26, p < 0.001). Conclusions: The results indicate that both spiritual intelligence and servant leadership are key predictors of work life quality in Peruvian nurses. SI contributes to developing a transcendent perspective on work and greater resilience, while SL fosters a positive and motivating organizational environment. It is recommended to implement training programs and leadership strategies focused on these constructs to enhance work life quality in the healthcare sector. Full article

Gender inequality remains a persistent issue in healthcare, especially in ophthalmology, where women face systemic barriers such as pay gaps, limited surgical opportunities, harassment, and unequal family expectations. Despite increasing entry into the field, women remain underrepresented in leadership, affecting career advancement and patient care. This study examines how virtual platforms, and co-led initiatives can address gender disparities in eye health. In 2021, Women in Ophthalmology, Seva Foundation, and Orbis International launched the Women’s Leaders in Eye Health (WLEH) initiative—a global community promoting mentorship, networking, and leadership development. Starting with virtual webinars and informal networking, the initiative expanded to in-person events in 2023 due to strong global engagement and demand. Early virtual programming, including webinars and “Coffee Hour” sessions, proved effective and laid the groundwork for broader offerings such as mentorship and professional development grants. WLEH’s success underscores the power of collaboration in promoting gender equity. By fostering connections and leadership pathways, WLEH offers a scalable model to break down gender challenges and uplift the next generation of women leaders to deliver more accessible eyecare globally. Full article

As Artificial Intelligence systems increasingly surpass or replace traditional human roles, institutions founded on beliefs in human cognitive superiority, moral authority, and procedural oversight encounter a more profound challenge than mere disruption: expiration. This paper posits that, instead of being outperformed, many legacy institutions are becoming epistemically misaligned with the realities of AI-driven environments. To clarify this change, the paper presents the Expiration Theory. This conceptual model interprets institutional collapse not as a market failure but as the erosion of fundamental assumptions amid technological shifts. In addition, the paper introduces the AI Pressure Clock, a diagnostic tool that categorizes institutions based on their vulnerability to AI disruption and their capacity to adapt to it. Through an analysis across various sectors, including law, healthcare, education, finance, and the creative industries, the paper illustrates how specific systems are nearing functional obsolescence while others are actively restructuring their foundational norms. As a conceptual study, the paper concludes by highlighting the theoretical, policy, and leadership ramifications, asserting that institutional survival in the age of AI relies not solely on digital capabilities but also on the capacity to redefine the core principles of legitimacy, authority, and decision-making. Full article

Background: Antimicrobial resistance (AMR) poses a critical global health challenge, particularly in resource-limited settings. A hub-and-spoke model, decentralising expertise and distributing resources to peripheral facilities, has been proposed as a strategy to enhance the antimicrobial stewardship (AMS) capacity in low- and middle-income countries. Aim: This study sought to understand healthcare professionals’ experiences of a hub-and-spoke AMS model in the Volta Region of Ghana and its influence on clinical practice, leadership, and collaborative endeavours to address AMR. Methods: A qualitative descriptive design was adopted. In-depth interviews were conducted with 11 healthcare professionals who participated in the AMS program. Thematic analysis was used to identify key themes related to the knowledge and skills that were gained, clinical and leadership practice changes, capacity building, and challenges. Results: Participants reported an increased awareness of AMR, particularly regarding the scale and clinical implications of antimicrobial misuse. The clinical practice improvements included more judicious prescribing and enhanced adherence to infection prevention and control measures. Many respondents highlighted stronger leadership skills and a commitment to capacity building through AMS committees, multidisciplinary collaboration, and cross-organisational knowledge exchange. Despite resource constraints and logistical hurdles, participants expressed optimism, citing data-driven approaches such as point prevalence surveys to track progress and inform policy. Engagement with hospital management and public outreach were viewed as essential to sustaining AMS efforts and curbing over-the-counter antibiotic misuse. Conclusions: The hub-and-spoke model caused observable improvements in AMS knowledge, clinical practice, and leadership capacity among healthcare professionals in Ghana. While challenges remain, particularly in securing sustainable resources and shifting community behaviours, these findings underscore the potential of network-based programs to catalyse systemic changes in tackling AMR. Future research should explore long-term outcomes and strategies for embedding AMS practices more deeply within healthcare systems and communities. Full article

Background/Objectives: This study protocol outlines the implementation of a professional development programme (ProDeveloP) designed to support newly graduated nurses (NGNs). NGNs often experience inadequacy and face challenges in developing their professional competence. Healthcare organisations can ease this transition through introduction programmes. However, effective implementation strategies in local healthcare settings remain unclear. This study aims to develop, implement, and evaluate a programme that enhances role clarity, task mastery, social acceptance, stress reduction, and recovery, contributing to increased job satisfaction and retention. Methods: ProDeveloP will be implemented at a regional hospital in mid-Sweden. This study will include a convenience sample of 110 NGNs from both the previous and the new introduction programmes, 20 dialogue facilitators involved in the programme, and 10 managers responsible for NGNs participating in the programme. Data will be collected throughout the ProDeveloP using questionnaires, individual interviews, and focus groups. The data will be analysed using both qualitative and quantitative analyses. Conclusions: This study has the potential to improve NGNs’ work-related health, job satisfaction, and retention while contributing to competence development. By offering structured reflection, mentorship, and organisational support, this research project addresses knowledge gaps in understanding the long-term impacts of introduction programmes and structured reflection, contributing to evidence-based improvements in nursing practice and healthcare leadership. Clinical trial number: NCT06742047. Registered in ClinicalTrials.gov, 19 December 2024. Full article

Background: Spirituality has emerged as a potential protective factor that may promote mental well-being and resilience among healthcare workers. Aim: This study aims to examine the relationship between spirituality, stress, and depression among healthcare professionals in Greece. Methods: This cross-sectional study surveyed 412 employees at the Corinth General Hospital in Greece, including medical, nursing, and administrative personnel. The data were collected using the Functional Assessment of Chronic Illness Therapy—Spiritual Well-Being 12 (FACIT-SP12), the Perceived Stress Questionnaire (PSQ), and the Center for Epidemiologic Studies Depression Scale (CES-D). The statistical analyses included non-parametric tests, correlation coefficients, and multiple regression. Results: The mean spirituality score was 34.6 (±6.83), while the stress and depression scores were 74.6 (±14.87) and 14.7 (±10.20), respectively. Spirituality was significantly and negatively correlated with both stress (r = −0.479, p < 0.001) and depression (r = −0.452, p < 0.001). Gender, years of service, educational level, and marital status were also associated with variations in stress, depression, and spirituality levels. Women and those with lower education reported significantly higher levels of stress and depression. Additionally, some demographic variables such as age and sector of employment did not show significant associations with spirituality or depression. The regression analysis confirmed spirituality as an independent predictor of lower stress levels (B = −1.158, p < 0.001). Conclusions: Spirituality is a significant predictor in mitigating stress and depression among healthcare workers. Promoting a supportive spiritual climate and incorporating elements of spiritual leadership in healthcare settings may enhance employee well-being and resilience. Future research should expand on these findings across diverse institutional and cultural contexts. Full article

Digital transformation is the process of using digital technologies for creating or modifying existing business processes and customer experience, leveraging cutting-edge technology to meet changing market needs. Disruptions like the COVID-19 pandemic, regional wars, and climate-driven natural disasters create consequential scenarios, e.g., global supply chain disruption creating further demand–supply mismatch for healthcare enterprises. According to KPMG’s 2021 Healthcare CEO Future Pulse, 97% of healthcare leaders reported that COVID-19 significantly accelerated the digital transformation agenda. Successful digital transformation initiatives, for example, digital twins for supply chains, augmented reality, the IoT, and cybersecurity technology initiatives implemented significantly enhanced resiliency in supply chain and manufacturing operations. However, according to another study conducted by Mckinsey & Company, 70% of digital transformation efforts for healthcare enterprises fail to meet their goals. Healthcare enterprises face unique challenges, such as complex regulatory environments, cultural resistance, workforce IT skills, and the need for data interoperability, which make digital transformation a challenging project. Therefore, this study explored potential barriers, enablers, disruption scenarios, and digital transformation use cases for healthcare enterprises. A structured literature review (SLR), followed by thematic content analysis, was conducted to inform the research objectives. A sample of sixty (n = 60) peer-reviewed journal articles were analyzed using research screening criteria and keywords aligned with research objectives. The key themes for digital transformation use cases identified in this study included information processing capability, workforce enablement, operational efficiency, and supply chain resilience. Collaborative leadership as a change agent, collaboration between information technology (IT) and operational technology (OT), and effective change management were identified as the key enablers for digital transformation of healthcare enterprises. This study will inform digital transformation leaders, researchers, and healthcare enterprises in the development of enterprise-level proactive strategies, business use cases, and roadmaps for digital transformation. Full article

Background: Organizational constraints in healthcare organizations influence nursing performance and patient outcomes. Head nurses’ leadership style might mitigate these effects and improve patient safety. This study aims to evaluate the role of ethical and authentic leadership styles in the relationship between organizational constraints and errors. Methods: A nationwide multicenter cross-sectional study evaluated nurses’ organizational constraints, errors, and leadership styles. A structural equation model tested the hypothesized relationship. Results: In total, 2349 nurses working in Italian healthcare organizations were enrolled. Negative associations were found between organizational constraints and leadership styles, and a positive relation with errors. Errors were negatively associated with both leadership styles. The structural equation model showed that leadership styles partially mediated the relationship between organizational constraints and errors. Conclusion: Healthcare organizations should promote and support head nurses in the adoption of ethical and authentic leadership to mediate organizational constraint effects, reduce errors, and enhance the caring quality. The head nurse plays a crucial role within healthcare organizations in mitigating the impact of organizational constraints and enhancing patient safety. Developing a leadership style means improving nurses’ well-being and reducing clinical errors for patients. Full article

Background/Objectives: Leadership in nursing plays a pivotal role in the provision of high-quality healthcare. It is, therefore, of paramount importance to understand the challenges encountered by newly qualified nurses when assuming leadership responsibilities. This scoping review protocol aims to identify and map these challenges, thereby facilitating the development of more effective interventions and support programmes. The data collection and analysis were conducted from January 2024 to March 2024. Methods: The review was conducted in accordance with the Joanna Briggs Institute (JBI) guidelines for scoping reviews and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) recommendations. A comprehensive search was undertaken across MEDLINE, CINAHL, Web of Science, Scopus, LILACS, and SciELO databases, in addition to a search for the grey literature. Study selection was performed by two independent reviewers, applying pre-defined inclusion and exclusion criteria. The data were extracted using a standardised form and analysed descriptively. Results: The review identified several key challenges faced by newly qualified nurses in leadership roles, including conflict management, decision-making under pressure, and effective communication. These findings highlight the complexity of transitioning from academic training to professional practice. The results provide a comprehensive overview of these challenges, enabling the identification of gaps in the existing knowledge base and informing the direction of future research and interventions. Conclusions: The findings of this review will contribute to the enhancement of healthcare quality and the promotion of the professional development of newly qualified nurses. This research underscores the importance of developing targeted interventions and support systems to address the specific challenges identified, thereby influencing nursing practice and policy. Full article

Background: European health systems are shifting toward more proactive, person-centered models, thereby highlighting the need to strengthen nurses’ clinical leadership in primary care. Nurse demand management (NDM) has emerged as an innovative practice which allows nurses to autonomously and comprehensively respond to a population’s health needs. However, knowledge on its implementation varies widely, often being intuitive, partly due to the absence of standardized evaluation tools. The xGID instrument aims to measure the degree of NDM adoption in primary care teams (PCTs), activating collective intelligence mechanisms to foster shared diagnosis, organizational reflection, and the generation of targeted recommendations. Methods: We designed and implemented xGID in 47 PCTs in Catalonia, involving 1474 healthcare professionals. Data were collected through structured surveys assessing key dimensions of NDM adoption, including professional autonomy, teamwork, continuity, and accessibility. Results: Overall adoption of NDM was high, with a mean score of 7.6 out of 10. Notable differences emerged between professional groups and practice areas. Nurses tended to be more critical of teamwork, longitudinal care, and accessibility, reflecting the central yet high-pressure role they play in NDM. High-scoring dimensions included professional autonomy and the capacity to act across multiple domains, whereas weaker areas pointed to systemic organizational challenges. Conclusions: The preliminary findings indicate that a standardized tool for NDM evaluation is a cornerstone for identifying contextual barriers and guiding the transformation of care models. Its participatory and strategic approach offers novel pathways to embed data-driven decision-making into daily clinical practice, consolidating NDM as a key pillar of future primary care. Full article

Green leadership is often praised for promoting sustainability, while hospitals in reactive or resource-constrained contexts lack the infrastructure to support leadership-led environmental change, indicating that leadership without operational capacity offers little impact. Moreover, the inconsistencies between green human resource practices and environmental performance suggest that green leadership might lead to symbolic gestures rather than real improvements without a robust environmental culture or internal accountability systems. Amid intensifying environmental regulations and sustainability mandates in healthcare, this study investigates how green transformational leadership addresses the contradiction between hospitals’ resource-intensive operations and environmental accountability. Drawing on Dynamic Capabilities Theory (DCT), the research highlights policy-driven imperatives for hospitals to build adaptive leadership models that meet sustainability goals. Using data from 312 junior doctors and nurses in private hospitals, analyzed via Partial Least Squares Structural Equation Modeling (PLS-SEM), the study identifies green attitude, green empowerment, and green self-efficacy as key mediators in enhancing environmental performance. Contributions of this study include (1) applying DCT to healthcare sustainability, (2) integrating psychological drivers into leadership–performance models, and (3) emphasizing nurses’ pivotal roles. The results of the study indicate that leaders who prioritize sustainability inspire staff to adopt eco-friendly practices, aligning with SDG 3, i.e., good health and well-being; SDG 12, i.e., responsible consumption and production; and SDG 7, i.e., affordable and clean energy. The findings provide actionable insights for hospital administrators and policymakers striving for environmentally accountable healthcare delivery. Full article

One of the emerging forms of cooperation in managing government projects is partnering (samspill) to address repetitive problems in large projects. Inefficiency, conflict, and cost volatility remain work issues in the public sector. Although risk sharing and incentive schemes are other aspects of partnering that are the subject of a significant amount of research, there is limited investigation into the softer aspects of partnering. The nature of partnering and how it is practiced depends on various components, such as trust, leadership, and culture; however, they are not well defined or appreciated. This paper investigates how these soft aspects are implemented and perceived in four mega Norwegian public construction projects that use a partnering model. In the present study, a qualitative research approach was adopted, and nine face-to-face interviews were conducted with project leaders from four case organizations in public sector healthcare, government, and education sectors. However, despite having similar contractual provisions, the projects exhibited varying degrees of collaboration success, indicating that formal agreements alone do not determine effective partnering. The outcomes from this study established that value-based leadership is central to the success of collaboration and should, therefore, be a priority when designing partnering in the public sector. Additionally, the results add to the existing debates regarding the application of soft values in the formal structures of the business and support the notion of leadership-based approaches in construction management, especially in the public domain. Full article

Healthcare institutions are under increasing pressure to deliver high-quality, patient-centered care while reducing their environmental footprint. Integrating quality and environmental management systems (ISO 9001 and ISO 14001) into a unified integrated management system (IMS) offers a potential pathway to meet these dual imperatives. This study investigates the effects of IMS implementation in three European hospitals through a comparative qualitative analysis of institutional reports, audit documentation, and performance indicators. The methodology combines a literature-informed conceptual framework with a multi-case analysis guided by four domains: environmental impact, care quality, process efficiency, and stakeholder engagement. The data were collected from institutional documentation over a six-year period (three years before and after IMS implementation), covering key indicators such as energy and water consumption, medical waste recycling, audit compliance, and patient satisfaction. The findings show that IMS adoption was associated with a 20–28% improvement in resource efficiency, increased recycling rates, and consistent gains in compliance and satisfaction metrics. These results were supported by strategic leadership, cross-functional training, and digital monitoring tools. The study concludes that IMS enhances institutional performance and sustainability while aligning healthcare operations with broader governance and policy goals. Further research is recommended to explore the long-term impacts and generalize the findings across healthcare systems. Full article