Purpose This study aims to explore how medical school deans develop as leaders within their institutional context, focusing on how they acquire decision-making capacity, exercise influence and sustain their roles in administration. Using Self-Determination Theory (SDT) as a lens, the study examines key components of leadership development, including autonomy, competence and relatedness. Design/methodology/approach A qualitative study design was employed using semi-structured interviews with medical school deans in Riyadh, Saudi Arabia. Participants were recruited via e-mail and provided informed consent prior to participation. Interviews were conducted virtually, audio-recorded and transcribed verbatim. Data were analyzed using framework analysis to identify themes aligned with the constructs of SDT. Findings Eight themes were identified across the three SDT domains. Autonomy was reflected in defining autonomy and role negotiation. Competence in leadership emerged through experiences of mastery, the influence of resources, participation in formal leadership programs and achievement of organizational goals. Relatedness was reflected in interpersonal relationships and personal fulfillment. These findings illustrate that leadership development is shaped by both individual experiences and institutional contexts. Research limitations/implications Although, this study sheds light on the complex interplay between leaders’ autonomy, motivation to lead and leaders’ ability to motivate others and how that contributes to organizational culture, a larger sample size, which includes deans from other Saudi Arabian cities, is needed for the findings to be transferable to other contexts. Furthermore, there was a lack of investigator triangulation. Time and access to the resources available for this research were constrained, both in terms of time and funding. As a result, the decision was made to streamline the analysis process to ensure the completion of the study within the specified constraints. Moreover, although the study shows a positive impression of leadership training programs, it does not measure actual outcomes or impact. As a result, the full effect of educational programs formal or informal cannot be determined. Practical implications Despite the methodological limitations of this study, the findings have several implications for educational practice and policy. First, at the individual level, leaders and candidates for administrative positions should be educated in their leadership roles. Leaders need to understand what role autonomy, competency and relatedness play in their development as leaders and how to best cultivate these aspects while practicing leadership. Second, in terms of the organizational level, policies regarding leadership recruitment and development of leaders belonging to the medical school need to be developed. Such policies may foster a better workplace culture that prioritizes leadership development, which may lead to efficient and effective organizations. Social implications This study highlights how leadership development in academic medicine extends beyond individual skill-building to social and organizational transformation. By viewing deans as learners embedded within relational, cultural and institutional contexts, it underscores that autonomy, competence and relatedness are socially constructed and sustained. Supporting these needs can improve workplace culture, reduce burnout and enhance collaboration among academic leaders. The findings suggest that fostering connected, motivated leadership in medical schools contributes not only to individual well-being but also to institutional resilience and the broader societal goal of developing effective, ethical and community-oriented health-care education systems. Originality/value This study contributes to the limited literature on leadership development among medical school deans by applying a theoretical lens to understand their lived experiences. It highlights that leadership development extends beyond technical skill acquisition and involves a dynamic process of negotiation autonomy, building competence and fostering meaningful professional relationships. The findings offer insights for designing contextually relevant leadership development initiatives in medical education.

Purpose The purpose of this paper is to evaluate whether the current body of leadership research in physical therapy uses contemporary themes and theories of leadership, evaluate the type of research being conducted and the quality of the research methodologies being used. Design/methodology/approach A search was conducted, adhering to PRISMA-ScR guidelines for scoping reviews. Inclusion and exclusion criteria were applied using data extraction tools for title/abstract and full text reviews. Reliability between authors was established for each tool. Data extracted included study design, classification of evidence, use of leadership theory and references to knowledge, skills, abilities and behaviors. Findings The search produced 153 articles for full-text review. A total of 79.7% were within the single discipline of physical therapy (“PT discipline”), and 20.2% included physical therapy and at least one additional health-care profession (“multidisciplinary”). Only 33.6% of “PT discipline” articles explicitly cited theory compared with 61.3% of the “multidisciplinary” articles. Of the “PT discipline” articles, descriptive research comprised 41.8%, narratives/commentaries 27%, qualitative research 28.7% and outcome studies 2.5%. Of the “multidisciplinary” articles, descriptive research comprised 54.8%, qualitative research 25.8% and outcome research 16.1%. Only two of the “PT discipline” and two of the “multidisciplinary” articles were rated at the highest level of evidence. Originality/value To the best of the authors’ knowledge, this is the only scoping review known to the authors that looks at the use of leadership theory and methodological rigor in the field of physical therapy leadership.

Purpose Patient safety’s inconsistent progress remains a prominent concern. Influential advocates recently identified faltering leadership in stalled initiatives. This study aims to identify how patient care quality and safety can be improved by analyzing leadership and organizational frameworks. Design/methodology/approach This multimethod study began with narrative review of existing literature on leadership for organizational frameworks in the context of patient-care quality and safety. The review informed development of scripted questions followed by semi-structured interviews with a purposeful sample of 11 healthcare leaders across Canada and the USA. Findings Key findings include consistent themes, along with indication by cited authors that important yet widely unfamiliar historical lessons from leading innovators along the past 100 years seem lost to institutional memory. Three themes emerged from the literature review: organizational ideology, the right leadership and organizational resilience. Several unique practical methods were discovered to be associated with consistent success. Additional interview themes include: a clear organizational mission, values and vision; personal values driving passion; all leaders and teams should collaborate; importance of a role model figure; importance of transparency; and flexibility to lead differently. Originality/value Important achievements and innovations exist in isolated examples. Now is the time to rethink leadership for organizations to widely steady a continuous evolution of patient care quality and safety progress. This manuscript identifies methods for improvement that have not been considered from business literature and recognizes current perspectives of healthcare leaders, for application in the realm of patient safety.

Purpose This study aims to explore the relationship between resilient leadership and organizational resilience in Ugandan healthcare systems, focusing on the mediating role of nurses’ well-being. Given the high-stress nature of healthcare, fostering organizational resilience through effective leadership and nurses’ well-being is crucial for sustaining quality service delivery. Design/methodology/approach A quantitative survey was conducted with 209 nurses across various healthcare facilities in Uganda. Data analysis was performed using the partial least squares (PLS) approach to examine the direct and mediating relationships between resilient leadership, nurses’ well-being and organizational resilience. Findings The results reveal that nurse well-being significantly mediates the relationship between resilient leadership and organizational resilience. This suggests that resilient leadership positively influences nurses’ well-being, which in turn enhances the overall resilience of healthcare organizations. Practical implications The study highlights the importance of integrating well-being initiatives into leadership strategies to strengthen healthcare institutions. Healthcare leaders should prioritize nurses’ well-being as a core component of resilience-building efforts. In addition, policymakers should support the implementation of well-being programs and leadership development initiatives to enhance organizational sustainability in healthcare. Originality/value This study contributes to the growing body of knowledge on resilience in healthcare by providing empirical evidence on the mediating role of nurses’ well-being. It underscores the significance of employee-centered leadership in fostering organizational resilience, particularly in resource-constrained healthcare systems.

Purpose This study aims to explore how hospital leadership manages conflicts arising from the risks and complexities of adopting Health Information Technology (HIT). Design/methodology/approach This qualitative study uses Yin’s (2014) case study methodology, drawing on in-depth interviews with leaders from a research hospital system and a critical access hospital to develop a conceptual model of leadership’s role in managing HIT-related conflicts. Findings This study identifies 30 factors related to HIT-related conflicts. Critical access hospitals face higher risks due to resource constraints, though their impact on stakeholders is lower. Increased complexity, shaped by close-knit cultures and reliance on external networks, is offset by reduced bureaucracy, enabling quicker decision-making. Leadership in both settings uses servant leadership and similar conflict management strategies, including process, content and motivational controls. Furthermore, heightened HIT-related conflicts correlate with adoption and implementation delays, prompting proactive leadership interventions. Originality/value This research fills a gap by examining how hospital leadership mediates conflicts during HIT adoption in a research hospital system and a critical access hospital.

Purpose This research used ethical leadership to engage doctors to implement an international National Institute for Clinical Excellence (NICE) guideline (NICE, 2014) in an emergency department (ED) in Nepal. The purpose of this study was to reduce unwarranted clinical variation in decision-making and thereby reduce unnecessary costs for patients by paying for computed tomography (CT) scans after a head injury where they are not clinically indicated. The World Health Organization (WHO) in its 17 Sustainable Development Goals (SDGs) (United Nations, 2017), identified SDG 3.8 as a goal to reduce “out-of-pocket” (OOP) health spending in low medium income countries (LMIC) to reduce poverty. Design/methodology/approach A quantitative study was designed, using a multiple-choice questionnaire based on the NICE head injury guideline 2014, with n = 27 doctors at pre- and post-training. Retrospective baseline patient data was collected from 149 patients (n = 149). These data were individually matched with the patient online record system and a detailed history, and the indication of CT head referral was reviewed on the clinical history part of the patient’s notes. A teaching session for doctors explained a flowchart for the NICE CT Head Guideline and different figures and case scenarios regarding patients presenting with a head injury were discussed. All data were collected and entered into a Microsoft Excel spreadsheet 2013. An analysis of the data was done by Statistical Package for Social Sciences version 18. A sample of 302 patients (n = 302) were followed up after implementation of the guideline in the department. Findings In this study, most common causes of head injury are RTA followed by physical assault and fall injury. There was no statistical difference in the type of injury p < 0.05. X2 (2, n = 454) = 2.4467, p = 0.2942, meaning that at both stages of the research the injury pattern was the same. Compliance has not improved statistically, and this may be due to a low power as it is only 44%. However, there is an appreciable improvement of compliance from 46.3% (before) to 56% (after), which is nearly 10% improvement. Translated to CT scans, this can be taken as reducing unnecessary CTs by 10%. Since 302 CTs were performed in the second phase, this study has demonstrated that nearly 30 unnecessary CT scans have been prevented from being carried out. If one CT cost 20 pounds, then the total saving was 600 pounds. If this study was undertaken over one month, then the total saving for a year would be 600 × 12 = 7200 pounds. Research limitations/implications This study set out to improve the quality of care provided to patients with a head injury who presented to an ED in Nepal. In Nepal as in other LMIC healthcare delivery is improving but there are still low levels of health insurance resulting in many patients having to pay OOP expenses for healthcare. The drive to undertake this study was influenced by the aim to reduce the amount of OOP expense incurred by patients for unnecessary CT head scans following a head injury. Measuring OOP expenses of a population helps to assess the impact on living standards and the impact of the health care financial system on improving financial protection (Hsu et al., 2018). It is also an important risk factor for death, physical disability and impoverishment (Baggio et al., 2018). In this study OOP expenses were reduced by 10% with the implementation of a clinical protocol. This study has shown a direct correlation between the training of doctors to implement a clinical protocol and the reduction of OOP expenses. Practical implications The WHO’s SDG 3.2 seeks to reduce “OOP expenses” in relation to healthcare. This study has shown that by implementing an international protocol, standardization in decision-making will be improved resulting in reducing “OOP” expenses in healthcare for patients. Social implications In LMIC, there is a need to identify practical and social strategies to prevent patients falling into poverty when accessing healthcare. This research study shows the potential for providing ethical leadership as a framework to support the implementation of a protocol to reduce OOP expenses for patients. Originality/value To the best of the authors’ knowledge, this is the first time a research study has identified the role of ethical leadership positioned with complex adaptive systems to promote the combined bottom-up and top-down approach of integrating ethical leadership in clinical research design to reduce OOP health expenses for patients in Nepal.

Purpose The purpose of this paper is to describe first-line managers’ (FLMs’) experiences and reflections on structural conditions for management practice within hospital settings using Kanter’s theory of structural empowerment. Design/methodology/approach A qualitative deductive approach with a descriptive design was used. Interviews were conducted with 11 FLMs in charge of medical or surgical hospital units spread across Sweden. Data were analyzed using a directed content analysis, based on Kanter’s theory of structural empowerment, encompassing such as access to necessary and sufficient resources, information, support and opportunities to learn and develop. Findings Findings of this study from the FLMs’ descriptions and reflections shed light on the impact of power dynamics on the structural conditions for management practice. The availability of nursing staff was a fundamental resource in the FLMs’ work performance, ensuring delivery of care to patients and a sound work environment for staff. Additionally, the other structural elements outlined in Kanter’s theory were evident in the findings, as the FLMs wished for structured information flow, identified potential and challenged opportunities for development and emphasized the importance of receiving support from people with a genuine understanding of their work situation. Originality/value The results of this study contribute to the understanding of FLMs’ structural conditions for management practice in hospital settings. The paper’s originality stems from the use of a deductive approach, providing a structured lens with the potential to inform future research and practice in the field of health-care management.

PurposeEmotional intelligence (EI) and authentic leadership are essential attributes for effective healthcare management. Understanding their interplay can inform leadership development and improve patient care outcomes. This study aims to determine the relationship between EI and authentic leadership among nurse managers.Design/methodology/approachStudy conducted a cross-sectional study, collecting data from 198 nurse managers using surveys assessing EI and authentic leadership. Correlation and regression analyses were used to explore the relationship and impact of EI on authentic leadership. STROBE checklist used to report the study.FindingsThe findings revealed a positive and significant relationship between nurse managers’ EI and their authentic leadership characteristics. Higher EI scores were associated with increased authenticity in leadership. EI, particularly interpersonal EI, plays a crucial role in authentic leadership. Enhancing nurse managers’ EI can foster more authentic leadership, positively impacting healthcare settings.Originality/valueThis research underscores the importance of EI in leadership development and its potential for improving patient care and organizational outcomes.

PurposeEmergency medicine can save lives and in 2018 the World Health Assembly passed resolution 72.16 ensuring the role of emergency care in all health systems. With a continued global shortage of emergency physicians, with many low-medium-income countries (LMIC) still to develop emergency medicine as a speciality, the role of emergency nurses is critical to deliver the WHO Emergency Care System Framework (WHO, 2018). Emergency medicine doctors play a critical role in collaborating with nurses, in emergency medicine where nurses are often the first clinicians are often the first clinicians to interact with patients in emergency care settings, making up the majority of health-care professionals in LMIC (Mamalelala, 2024). Yet emergency nursing has yet to become established in Nepal, where nurses are often recruited to emergency departments, without having received any training in emergency or critical care treatment and management. The purpose of this paper is to outline a collaborative leadership approach to co-design an airway, breathing, circulation, disability, exposure (ABCDE) structured approach to an emergency nursing training module designed for nurses to feel empowered in the emergency department and to report on its findings.Design/methodology/approachThis study draws upon mixed methodology research, enrolling 30 nurses (n = 30) from an emergency department in a tertiary hospital in Nepal through three stages of the project: Stage 1: training module co-design, collaborative leadership exploring the rationale for a training module and core features of design based on the ABCDE of emergency medicine; Stage 2: quantitative data were collected to assess baseline pre- and post-intervention knowledge and follow-up knowledge assessment at 30 and 45 days; Stage 3: qualitative data were collected with 24/30 (80%) nurses to evaluate the impact and application of the nurses ABCDE learning 7 months post-training. The qualitative survey was undertaken using online Google Forms.FindingsNurses were fully engaged in the co-design and collaboration of the development of an ABCDE training module which was delivered over 3 h. Full engagement was secured from all nurses in the department, and there were statistically significant advances in ABCDE emergency knowledge from the baseline, however, this knowledge began to decrease at 30 and 45 days. A follow-up qualitative survey was distributed to nurses seven months after training with an 80% return rate, which reported a range of examples of how nurses were continuing to apply their learning in practice.Originality/valueThis training module for emergency nurses was designed collaboratively from the “bottom up” in a tertiary hospital in Nepal, recognising the need to develop emergency nursing in the emergency department. The data revealed promising findings, while knowledge decreased from the post-training questionnaire, qualitative evidence revealed significant changes in practice, with the greatest reported change in the management of the airway. While this training module has made a difference in the quality of care provided, there is a need for a country-wide strategy in this area otherwise it is likely that such an initiative will only be developed by hospitals at a local level (Lecky, 2014). Education and training initiatives for nurses that focus on an evidence-based approach to clinical practice can bridge the workforce gap in the short term, however, the Government of Nepal must decide on establishing a recognised post-graduate sub-specialty in emergency nursing, the duration of training, who should be trained and what curriculum should be followed (Lecky, 2014).

PurposeGovernments faced formidable challenges in coordinating public health responses to the COVID-19 pandemic. This study aims to enhance the understanding of effective organizational leadership during crises by investigating the factors influencing the turnover of health leaders during the COVID-19 pandemic in Brazil.Design/methodology/approachUsing primary data encompassing all appointments and dismissals of federal and state health secretaries, this paper conducted a quantitative analysis of the relational and reputational factors that contributed to leader turnover during the COVID-19 pandemic. This paper also examined whether leaders’ management and public health experience increase the duration of tenure.FindingsStates encountered significant challenges in retaining experienced and effective leadership during the health emergency, primarily due to political conflicts in policymaking and, to a lesser extent, allegations of corruption. Furthermore, leaders with expertise in public health were found to be less likely to be removed from office. However, managerial experience did not prolong the tenure of state health secretaries during the emergency.Research limitations/implicationsSince most health leaders have public health and management experience, the contributions of each factor to the duration of a secretary’s tenure are difficult to separate and analyze separately.Practical implicationsThis study provides empirical insights into what factors drive health leader turnover during major health emergencies.Social implicationsDuring major health emergencies, health leaders often strongly disagree with elected officials on the response. This paper test how crisis leadership theories help explain state health leaders’ duration in one of the world’s largest public health systems during the COVID-19 pandemic. This paper find that policy disagreements contributed to significant turnover.Originality/valueTo the best of the authors’ knowledge, this paper is the first that are aware of that uses novel primary data on public health executive leader characteristics and turnover causes in the context of the COVID-19 pandemic. It provides empirical evidence contributing to the crisis leadership literature by examining health leader turnover in one of the world’s largest public health systems.