Leadership in Health Services最新文献

{"title":"Crisis leadership and power dynamics in Portuguese hospitals: organisational learning from COVID-19.","authors":"Paula Cristina de Almeida Marques","doi":"10.1108/LHS-11-2025-0183","DOIUrl":"10.1108/LHS-11-2025-0183","url":null,"abstract":"<p><strong>Purpose: </strong>This paper aims to examine how power struggles, competing leadership logics and governance failures shaped organisational learning and crisis response in Portuguese public hospitals during the COVID-19 pandemic. By analysing tensions between managerial, clinical and political actors, this study explores how fragmented authority and informal leadership networks conditioned hospitals' adaptive capacity under sustained systemic pressure.</p><p><strong>Design/methodology/approach: </strong>This study draws on 41 semi-structured interviews with hospital managers, clinical leaders and frontline coordinators across three major public hospitals, complemented by documentary analysis of contingency plans, internal communications and official reports. A deductive thematic analysis was conducted, supported by systematic triangulation, inter-coder validation and critical incident reconstruction.</p><p><strong>Findings: </strong>Three interrelated patterns emerged: strained relationships between hospital management and central and regional authorities undermined coordination and trust; informal leadership networks developed within clinical departments to address operational bottlenecks, frequently bypassing formal hierarchies; and political interference intensified power rivalries, reducing coherence, transparency and institutional learning. Although these dynamics often constrained organisational learning, they also enabled pockets of rapid local adaptation driven by autonomous clinical leadership.</p><p><strong>Research limitations/implications: </strong>This study is limited by its focus on three large hospitals in Northern Portugal, which restricts generalisation to other regions or smaller institutions. The qualitative design, although suitable for exploring governance dynamics, captures perceptions that may be influenced by hindsight bias and the exceptional pressures of the pandemic. The absence of quantitative performance indicators limits the ability to assess the measurable effects of governance tensions. Future research should incorporate mixed methods, include diverse organisational contexts and examine longitudinal integration of informal practices into formal governance and learning systems.</p><p><strong>Practical implications: </strong>Hospitals require governance arrangements that recognise and integrate informal leadership and frontline expertise during crises. Strengthening transparent communication channels, formalising multi-level coordination mechanisms and embedding learning processes within crisis governance frameworks are critical for enhancing resilience and leadership effectiveness.</p><p><strong>Social implications: </strong>This study highlights how governance tensions during the COVID-19 pandemic affected not only hospital functioning but also the broader social experience of healthcare. Unclear authority structures and delayed decisions contributed to public uncertainty, reduced confidence in health i","PeriodicalId":46165,"journal":{"name":"Leadership in Health Services","volume":" ","pages":"416-435"},"PeriodicalIF":2.3,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leadership-as-practice to improve hand hygiene: a mixed-methods study in a Nepal emergency department.","authors":"Ashish Karn, Jill Aylott, Dayaram Lamsal, Asmita K C, Anisha Adhikari, Buddhike Sri Harsha Indrasena","doi":"10.1108/LHS-07-2025-0124","DOIUrl":"10.1108/LHS-07-2025-0124","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to examine the application of a leadership-as-practice (L-A-P) approach to improve hand hygiene compliance in a resource-limited emergency department (ED) in Nepal. Poor hand hygiene remains a major contributor to health care-associated infections, and traditional hierarchical leadership approaches often fail to achieve sustained behavioural change. By conceptualising leadership as a shared, practice-based process, this study aimed to embed hand hygiene into everyday clinical work, promote shared accountability and strengthen patient safety culture within a high-pressure ED setting.</p><p><strong>Design/methodology/approach: </strong>A mixed-methods intervention was conducted in three phases: pre-training baseline assessment, immediate post-training evaluation and a 14-day follow-up. Sixty health-care workers, including doctors, nurses, paramedics and support staff, participated. The intervention combined experiential hand hygiene training using Glo Germ gel and ultraviolet light with facilitated discussion, real-time feedback and peer engagement, guided by L-A-P principles. Quantitative data on hand hygiene knowledge and observed compliance were analysed using appropriate statistical tests, while qualitative data were thematically analysed to explore leadership behaviours, teamwork and cultural change.</p><p><strong>Findings: </strong>Observed hand hygiene adherence increased from 31% at baseline to over 80% immediately post-training and was maintained at the 14-day follow-up. Knowledge scores improved significantly across all professional groups. Qualitative findings indicated enhanced peer accountability, increased willingness to challenge unsafe practice across hierarchical boundaries and early signs of cultural change towards shared leadership and collective responsibility for patient safety.</p><p><strong>Research limitations/implications: </strong>This study was conducted in a single ED using a convenience sample and a short 14-day follow-up, which limits generalisability and long-term inference. Observational assessment may have been influenced by the Hawthorne effect, although triangulation with qualitative data strengthens credibility. As an exploratory pilot, the findings highlight the feasibility and potential value of L-A-P for patient safety improvement. Future research should use multi-site designs, longer follow-up periods and patient-level outcomes to assess sustainability, transferability and clinical impact.</p><p><strong>Practical implications: </strong>This study shows that even in a busy, low-resource ED, real change is possible using simple tools and shared leadership. By involving staff in hands-on training and making leadership part of everyday work, hand hygiene practices improved quickly and those improvements lasted. Tools like Glo Germ and UV light made the training engaging and memorable. The approach did not rely on external experts or expensive resources, which makes it ","PeriodicalId":46165,"journal":{"name":"Leadership in Health Services","volume":" ","pages":"329-349"},"PeriodicalIF":2.3,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148253756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Superior leadership as a predictor of effective error management: insights from the Saudi Ministry of Health.","authors":"Sanaa Mostafa Mohammed, Mohammed Thani Alhumaid","doi":"10.1108/LHS-07-2025-0120","DOIUrl":"10.1108/LHS-07-2025-0120","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to address a critical gap by investigating how superior leadership (SL) influences error management (EM) at the Saudi Ministry of Health (MOH). It empirically explores how SL dimensions like empowerment foster a comprehensive EM in a non-Western context, moving beyond general assumptions to provide needed, context-specific empirical insights.</p><p><strong>Design/methodology/approach: </strong>A descriptive and analytical design was used, using a survey approach. Data was collected from a simple random sample of 322 MOH employees in Saudi Arabia. A customized questionnaire measured both EM and SL dimensions as defined within this research.</p><p><strong>Findings: </strong>Results reveal that SL significantly impacts EM. \"Encouraging creativity/innovation\" promoted error reporting by mitigating fear of reprisal, whereas empowerment was found to enhance organizational learning. A \"supportive environment\" promoted knowledge sharing, fostering a positive EM.</p><p><strong>Research limitations/implications: </strong>Despite the limited focus and survey methodology of this study, it highlights the pivotal role of leadership in health emergencies. It calls for MOH policies to promote leadership excellence and a learning culture through training and empowerment. By addressing this gap, the present study provides new regional insights, necessitating further research on this dynamic.</p><p><strong>Originality/value: </strong>This study's originality lies in empirically investigating how specific leadership dimensions influence EM facets in the novel context of the Saudi MOH. It fills a research void by providing context-specific evidence, moving beyond generalizations to offer an empirically backed understanding of leadership's critical role in building resilient systems.</p>","PeriodicalId":46165,"journal":{"name":"Leadership in Health Services","volume":" ","pages":"436-458"},"PeriodicalIF":2.3,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Foundations for leadership development programs for advanced practice providers.","authors":"Alisa Gifford, Daniel Regan","doi":"10.1108/LHS-05-2025-0078","DOIUrl":"https://doi.org/10.1108/LHS-05-2025-0078","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study is to synthesis current literature and propose a hospital leadership structure that includes Advanced Practice Providers (APPs). Additionally, this study identified the need for formal leadership training for APPs like those that have been created for physicians which have shown to improve leadership skills, patient care and hospital performance. This study proposes a core foundational structure for leadership programs for APPs for hospitals to enact.</p><p><strong>Design/methodology/approach: </strong>This study is a scoping review and narrative synthesis. Particular attention was paid to literature pertaining to APP leadership position creation as well as leadership development training programs.</p><p><strong>Findings: </strong>APPs are essential in the delivery of quality patient care in hospital systems. With the increase in the number of APPs employed at hospital systems, there is a lack of opportunity for leadership positions or leadership training. A few hospital systems have reported departmental or hospital creation of leadership positions for APPs, which have found improvement in APP retention and job satisfaction. There needs to be a widespread and uniform transition in the leadership structure to include APPs.</p><p><strong>Research limitations/implications: </strong>Literature review relied on published literature and institutional reports, which may be subject to publication bias and variability in reporting quality. Additionally, much of the available literature was US-based, which may limit international generalizability. The available literature was limited by variability in study design, frequent reliance on single-institution reports and lack of outcome data limited comparative evaluation of leadership models. Few studies reported measurable leadership or patient outcomes, constraining comparative evaluation. The absence of standardized leadership metrics constrained formal quality appraisal. Additionally, APP-specific leadership literature remains relatively sparse, requiring selective inclusion of physician and nursing leadership studies to identify transferable models and competencies.</p><p><strong>Originality/value: </strong>This paper fills a gap of knowledge by identifying a lack of unity of leadership positions and lack of formal APP leadership training at the institutional level. Creation of APP leadership positions with formal leadership development training will improve APP job satisfaction, retention, quality of patient care and culture of the hospital system.</p>","PeriodicalId":46165,"journal":{"name":"Leadership in Health Services","volume":" ","pages":"1-15"},"PeriodicalIF":1.8,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148253775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adaptive leadership over time: activation, adaptation and service commitment in health care.","authors":"Duy Phan Khanh, Phuc Nguyen","doi":"10.1108/LHS-01-2026-0016","DOIUrl":"https://doi.org/10.1108/LHS-01-2026-0016","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to address the unresolved temporal puzzle in health-care leadership research by examining why adaptive leadership reliably activates early engagement yet fails to sustain or reverses its effects under prolonged exposure.</p><p><strong>Design/methodology/approach: </strong>Using a three-wave longitudinal design (n = 451) across public health-care organisations, the study applies random intercept cross-lagged panel modelling to disentangle within-person dynamics from stable between-person differences. Time-ordered mediation and moderation pathways linking adaptive leadership, job resources, job demands, work engagement, workload intensity and commitment to service quality are estimated.</p><p><strong>Findings: </strong>Adaptive leadership recalibrates across temporal phases, functioning as a phase-sensitive activation process an activation-oriented trigger that produces early gains in job resources and engagement. Over time, the same leadership behaviours generate cumulative job demands that erode engagement and suppress downstream service commitment. These effects exhibit pronounced lag asymmetries and non-monotonic trajectories, with workload intensity accelerating the shift from benefit-driven to cost-driven mechanisms.</p><p><strong>Originality/value: </strong>The study reconceptualises adaptive leadership effectiveness as temporally phase-dependent, identifying the temporal mis-fit between persistent activation-oriented behavioural repertoires and evolving consolidation demands as the proximate mechanism of declining effectiveness; extends job demands-resources theory into a longitudinal leadership process model; and establishes non-monotonic leadership effects as a systematic property of sustained health-care work systems rather than a boundary anomaly.</p>","PeriodicalId":46165,"journal":{"name":"Leadership in Health Services","volume":" ","pages":"1-16"},"PeriodicalIF":1.8,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148253758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Self-management and home-based HIV/AIDS care in Tanzania.","authors":"Randolph K Quaye","doi":"10.1108/LHS-03-2025-0054","DOIUrl":"10.1108/LHS-03-2025-0054","url":null,"abstract":"<p><strong>Purpose: </strong>Adherence to antiretroviral therapy (ART) is a major contributor to the success of treating people with HIV/AIDS. This study aims to explore the degree to which human immunodeficiency virus and acquired immune deficiency (HIV/AIDS) infected individuals, especially those who routinely visit antiretroviral clinics would prefer to receive their treatment at home rather than at the clinic.</p><p><strong>Design/methodology/approach: </strong>Fifty semistructured and in-depth interviews were used to collect data. Based upon systematic review of the literature on self-management of people living with HIV/AIDs, the authors developed specific questions that explored the respondents' views on self-management, adherence to ART, stigma and overall attitudes of their health-care providers.</p><p><strong>Findings: </strong>The majority of the respondents reported learning about their HIV/AIDS status through voluntary testing, and that a majority of them preferred accessing care through their clinic. About half of them have informed their spouses or relatives about their HIV/AIDS status. They overwhelmingly were satisfied with services provided by their health-care providers. To better scale-up antiretroviral services, several studies have suggested that the government should play a major role in providing resources and income-generating programs to assist patients financially.</p><p><strong>Research limitations/implications: </strong>The findings lend credence to the impact of ART programs in improving and prolonging the lives of Tanzanian individuals living with HIV/AIDS. It is the hope that the global effort in this campaign, especially through the U.S. Presidential Emergency Fund for AIDS Relief will continue. The current proposal to defund this program should be reconsidered for the sake of millions of individuals living with HIV/AIDS globally.</p><p><strong>Practical implications: </strong>This is a call to action by governments, nongovernmental organizations and the larger international community to harness resources to scale-up treatment for individuals living with HIV/AIDS.</p><p><strong>Social implications: </strong>The burden of HIV/AIDS has complicated the current plight of patients. Expanding antiretroviral services will help reduce the excess death facing many developing and developed nations.</p><p><strong>Originality/value: </strong>The knowledge gained in this study may benefit society by accessing how clinic and home-based care can be an effective tool of extending antiretroviral services to patients seeking care. While the geographically limited ample size makes generalizations to all of Tanzanian society impossible, nevertheless, the findings lend credence to the impact of ART programs in improving and prolonging the lives of Tanzanian. It is the hope that the global effort in this campaign will continue.</p>","PeriodicalId":46165,"journal":{"name":"Leadership in Health Services","volume":" ","pages":"169-186"},"PeriodicalIF":2.3,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147365749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating community perceptions of leadership in decentralized governance during public health crisis: a case study from Thrissur district, Kerala (India).","authors":"Kiran Prakash Vattamparambil, Suhita Chopra Chatterjee","doi":"10.1108/LHS-04-2025-0062","DOIUrl":"10.1108/LHS-04-2025-0062","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to investigate how demographic variables - specifically age, gender and income - influenced community perceptions of decentralized governance leadership during the COVID-19 crisis in Elavally Panchayat, Kerala. It explores residents' varied experiences with local service delivery and support mechanisms, revealing disparities in satisfaction and access. The findings underscore the importance of inclusive, adaptive and crisis-responsive local leadership during public health emergencies.</p><p><strong>Design/methodology/approach: </strong>Adopting a mixed-methods approach, this study combined unstructured interviews with elected local self-government leaders and primary health centre staff with a structured household survey. The survey included first 100 household respondents drawn from confirmed COVID-19 cases across all 16 wards. Six dimensions of governance performance were assessed using a three-point Likert scale (Satisfied, Neutral and Dissatisfied). Descriptive statistics and chi-square tests (p < 0.05) were applied to examine demographic variations in satisfaction levels. Qualitative insights from interviews further contextualized and deepened the findings.</p><p><strong>Findings: </strong>The results indicate significant demographic disparities in perceived leadership effectiveness. Younger adults appreciated digital welfare schemes but felt excluded from local decision-making. Middle-aged residents experienced severe healthcare and livelihood disruptions, while elderly individuals struggled with digital health systems. Women expressed higher satisfaction due to targeted welfare schemes, whereas men cited unmet mental health and economic needs. Lower-income groups reported barriers to accessing essential services. Nonetheless, decentralized governance grounded in trust, equity and participatory approaches enabled an effective, context-specific crisis response.</p><p><strong>Originality/value: </strong>Unlike studies that treat communities as homogeneous, this research disaggregates perceptions, offering policy insights to strengthen equity and resilience in local health governance.</p>","PeriodicalId":46165,"journal":{"name":"Leadership in Health Services","volume":" ","pages":"226-246"},"PeriodicalIF":2.3,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145913358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Empowering adaptive leadership: a dynamic adaptive approach.","authors":"Anke Aarninkhof-Kamphuis, Hans Voordijk, Geert Dewulf","doi":"10.1108/LHS-07-2025-0121","DOIUrl":"10.1108/LHS-07-2025-0121","url":null,"abstract":"<p><strong>Purpose: </strong>Adaptive leadership and dynamic adaptive approaches to decision-making are becoming increasingly important for organizations operating in complex and uncertain environments. This study aims to examine how the utilization of a dynamic adaptive approach influences adaptive leadership within strategic processes. Adaptive leadership enables organizations to navigate unpredictable challenges by fostering resilience, learning and change, while the applied dynamic adaptive approach supports strategic decision-making under deep uncertainty.</p><p><strong>Design/methodology/approach: </strong>A qualitative multiple-case study design was used, involving four Dutch healthcare organizations - two elder care organizations and two disability care organizations. Each organization participated in a strategic decision-making workshop in which a dynamic adaptive approach was applied. Data were collected through workshop observations, interviews and supporting documentation.</p><p><strong>Findings: </strong>The findings show that the applied dynamic adaptive approach strengthens a supportive environment and contributes to sensemaking necessary, helping participants engage with long-term uncertainties and strategic complexity. This, in turn, encouraged behaviors and mindsets associated with adaptive leadership. However, the study also reveals limitations: a single workshop is not sufficient to fully design an intervention for an organization and develop adaptive leadership capabilities. Iterative, ongoing engagement is necessary to build strategic resilience and adaptive capacity.</p><p><strong>Originality/value: </strong>This research complements recent calls for more empirical research on adaptive leadership and foresight approaches. The study reveals how the dynamic adaptive approach in strategic decision-making processes empowers adaptive leadership. This is especially important in today's complex organizations facing deep uncertainties in a rapidly changing environment.</p>","PeriodicalId":46165,"journal":{"name":"Leadership in Health Services","volume":" ","pages":"247-265"},"PeriodicalIF":2.3,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145999398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining the relationship between transformational leadership, organizational culture and organizational change perception in a hospital setting: a structural equation modeling approach.","authors":"Mustafa Orhan, Yasemin Akbulut","doi":"10.1108/LHS-10-2025-0167","DOIUrl":"10.1108/LHS-10-2025-0167","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to examine how transformational leadership influences organizational change perception in accredited and digital hospitals, and whether organizational culture subdimensions mediate this relationship.</p><p><strong>Design/methodology/approach: </strong>This cross-sectional and explanatory study was conducted in two public hospitals in Izmir, Türkiye, both accredited and holding digital hospital certificates. Using stratified sampling to ensure professional representation, data were collected from 527 employees. Structural equation modeling was used to analyze the relationships among variables.</p><p><strong>Findings: </strong>Transformational leadership was found to have a significant effect on organizational change perception (β = 0.614). When organizational culture subdimensions were included as mediators, the effect size decreased to β = 0.179, indicating a partial mediating effect. Among the mediators, adhocracy culture, clan culture, hierarchy culture and market culture showed differing indirect effects in this relationship. The findings highlight the importance of organizational culture in shaping change perceptions in hospital settings.</p><p><strong>Practical implications: </strong>The study highlights that strengthening transformational leadership practices and fostering an adhocracy-oriented culture can improve hospitals' readiness for organizational change, such as accreditation and digital transformation, while also supporting employee engagement and successful change initiatives.</p><p><strong>Originality/value: </strong>By focusing on hospitals undergoing both accreditation and digitalization, this study contributes to understanding how leadership and culture interact in complex healthcare environments. The results offer practical insights for health managers aiming to foster successful change through cultural development and transformational leadership.</p>","PeriodicalId":46165,"journal":{"name":"Leadership in Health Services","volume":" ","pages":"266-278"},"PeriodicalIF":2.3,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146133250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive unit-based safety program in practice: high reliability organising, patient safety and organisational human factors in Victoria's public healthcare system - a qualitative study.","authors":"Clare McCarthy, Bill Shearer, Katharine See, Elizabeth Austin, Robyn Clay-Williams","doi":"10.1108/LHS-03-2025-0044","DOIUrl":"10.1108/LHS-03-2025-0044","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to explore organisational human factors in implementing and evaluating the Comprehensive Unit-based Safety Program (CUSP) as part of a high reliability organisations (HROs) framework for improving patient safety in a public hospital setting in Victoria, Australia.</p><p><strong>Design/methodology/approach: </strong>A qualitative study using semi-structured interviews with 15 participants from seven CUSPs was conducted. Participants represented diverse clinical and non-clinical roles, selected based on program maturity and availability. Data were collected between August 2022 and March 2023, with thematic analysis using deductive and inductive coding. Reflexive practices, including transcript verification and peer debriefing, ensured rigour.</p><p><strong>Findings: </strong>CUSP emerged as vital for fostering leadership, accountability, teamwork and psychological safety - pillars of a robust safety culture. Thematic analysis revealed three core themes: HRO Principles, Organisational Human Factors and Quality and Safety. CUSP's integration of timely, actionable safety data enhanced teamwork, flattened hierarchies and drove collaborative improvements in patient safety. By blending technical and adaptive elements, the program cultivated a proactive safety culture. These findings emphasise embedding human factors and leadership into safety programs while identifying a need for further research into CUSP's scalability and long-term impact.</p><p><strong>Practical implications: </strong>CUSP's adaptable, data-driven approach can embed patient safety into organisational practices. Healthcare organisations can leverage this study's insights to prioritise leadership, promote psychological safety and ensure data accessibility for staff.</p><p><strong>Originality/value: </strong>To the best of the authors' knowledge, this is the first Australian study to examine CUSP within a HRO context, highlighting how leadership and teamwork underpin safety program success in public healthcare.</p>","PeriodicalId":46165,"journal":{"name":"Leadership in Health Services","volume":" ","pages":"187-201"},"PeriodicalIF":1.8,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145890467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}