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Background Achieving high levels of patient satisfaction requires hospital management to be proactive in patient-centred care improvement initiatives and to engage frontline clinicians in this process. Method We developed a survey to assess the attitudes of clinicians towards hospital management activities with respect to improving patient satisfaction and surveyed clinicians in four academic hospitals located in Denmark, Israel, the UK and the USA. Results We collected 1004 questionnaires (79.9% response rate) from four hospitals in four countries on three continents. Overall, 90.4% of clinicians believed that improving patient satisfaction during hospitalisation was achievable, but only 9.2% of clinicians thought their department had a structured plan to do so, with significant differences between the countries (p<0.0001). Among responders, only 38% remembered targeted actions to improve patient satisfaction and just 34% stated having received feedback from hospital management regarding patient satisfaction status in their department during the past year. In multivariate analyses, clinicians who received feedback from hospital management and remembered targeted actions to improve patient satisfaction were more likely to state that their department had a structured plan to improve patient satisfaction. Conclusions This portrait of clinicians’ attitudes highlights a chasm between hospital management and frontline clinicians with respect to improving patient satisfaction. It appears that while hospital management asserts that patient-centred care is important and invests in patient satisfaction and patient experience surveys, our findings suggest that the majority do not have a structured plan for promoting improvement of patient satisfaction and engaging clinicians in the process.

Medical disputes are a significant challenge in healthcare settings worldwide, with hospital administrators playing a pivotal role in managing the conflicts. In China, despite a reported decline, medical disputes continue to raise public and governmental concerns due to factors such as medical accessibility, patient expectations, and staff competency. This study aimed to explore the lived experiences and perspectives of Chinese hospital administrators directly engaged in medical dispute management, to understand the challenges they face and inform the development of targeted training and support systems. Using a qualitative phenomenological approach, we conducted semi-structured, in-depth interviews with 13 hospital administrators from two major regional comprehensive hospitals in Beijing. Participants were selected through purposive sampling and met criteria including active engagement in managing medical disputes and adequate communication skills. Data were analyzed using Colaizzi’s thematic analysis method to extract significant themes from the participants’ experiences. Administrators reported four interconnected challenges: how gender shapes authority and perceived safety in disputes; the struggle to maintain an impartial, ‘outsider’ stance; wide variability in the emotional toll of conflict; and a pronounced need for structured, ongoing dispute-management training. The key themes revealed included (1) Gender Dynamics in Conflict Management: female administrators faced challenges in authority recognition and preferred having male colleagues present during intense disputes for perceived safety and effectiveness; (2) Outsider Perspective in Conflict Management: maintaining an impartial and detached stance was crucial for effective mediation, but administrators varied in their ability to achieve this mindset; (3) Variability in Psychological Experiences: administrators reported diverse emotional reactions and psychological impacts. Some struggled to detach emotionally and lacked formal support systems; (4) Need for Specific Training: there was a clear demand for structured, ongoing training programs tailored to the unique challenges of medical dispute management. Chinese hospital administrators face complex challenges including emotional strain, mixed-gender preference in intense encounters, and insufficient training and support. Addressing the issues is essential for enhancing administrators’ effectiveness in conflict resolution, improving patient care outcomes, and promoting organizational efficiency. Medical institutions should develop comprehensive training programs and establish support systems for administrators’ well-being.

Background A competent management workforce is crucial to achieve the effectiveness and efficiency of health service provision and to lead and manage the health system reform agenda. However, the traditional recruitment and promotion approach of relying on clinical performance and seniority provides limited incentives for competency development and improvement among hospital managers in Iran. There is limited evidence on the competency development needs of hospital managers in Iran that can guide setting training and development direction. This study aims to identify the competency development needs of three management levels (senior, mid-level, and frontline) in public hospitals and explore the difficulties that managers experienced. Methods The study adopted a cross-sectional survey using the validated management competency assessment partnership (MCAP) tool. The MCAP tool, consisting of 82 behavioral items that measure six core management competencies, was distributed to 162 public hospitals in 19 provinces in Iran between September 2021 and March 2022. The data were analyzed using descriptive and inferential statistics including the mean and standard deviation, chi-square test, independent-samples t-test, and one-way analysis of variance. Results In total, 1051 managers completed the survey either online or on paper. Peer and team conflict, employee performance, loss of skilled staff, and supervisor confrontation were the five difficulties most often encountered by all three levels of managers. The survey confirmed that only a small proportion of managers had the opportunities to participate in formal and informal management-related education/training, such opportunities were much lower for middle and frontline managers ( P  < 0.001). Middle managers were less confident in their demonstration of the core management competencies than that of senior and frontline managers ( P  < 0.001). Managers who completed management training organised internally by the hospitals consistently received higher mean competency scores for all competencies ( P  < 0.001). Conclusion The study provides compelling evidence highlighting the importance of developing strategies to systematically enhance the capabilities of hospital managers, particularly mid-level managers. Incentives to encourage hospital managers to participate in both formal and informal management training, along with the commitment from hospitals to establish mechanisms that build management capacity, support managers, and guide the preparation and recruitment of management positions, are essential.

Speaking of the public response to the deaths of children at the Bristol Royal Infirmary before 2001, the BMJ commented that the NHS would be ‘all changed, changed utterly’. Today, two inquiries into the Mid Staffordshire Foundation Trust suggest nothing changed at all. Many patients died as a result of their care and the stories of indifference and neglect there are harrowing. Yet Bristol and Mid Staffordshire are not isolated reports. In 2011, the Health Services Ombudsman reported on the care of elderly and frail patients in the NHS and found a failure to recognise their humanity and individuality and to respond to them with sensitivity, compassion and professionalism. Likewise, the Care Quality Commission and Healthcare Commission received complaints from patients and relatives about the quality of nursing care. These included patients not being fed, patients left in soiled bedding, poor hygiene practices, and general disregard for privacy and dignity. Why is there such tolerance of poor clinical standards? We need a better understanding of the circumstances that can lead to these outcomes and how best to respond to them. We discuss the findings of these and other reports and consider whether attention should be devoted to managing individual behaviour, or focus on the systemic influences which predispose hospital staff to behave in this way. Lastly, we consider whether we should look further afield to cognitive psychology to better understand how clinicians and managers make decisions?

Large language model (LLM) artificial intelligence (AI) tools have the potential to streamline health care administration by enhancing efficiency in document drafting, resource allocation, and communication tasks. Despite this potential, the adoption of such tools among hospital administrators remains understudied, particularly at the individual level. This study aims to explore factors influencing the adoption and use of LLM AI tools among hospital administrators in China, focusing on enablers, barriers, and practical applications in daily administrative tasks. A multicenter, cross-sectional, descriptive qualitative design was used. Data were collected through semistructured face-to-face interviews with 31 hospital administrators across 3 tertiary hospitals in Beijing, Shenzhen, and Chengdu from June 2024 to August 2024. The Colaizzi method was used for thematic analysis to identify patterns in participants' experiences and perspectives. Adoption of LLM AI tools was generally low, with significant site-specific variations. Participants with higher technological familiarity and positive early experiences reported more frequent use, while barriers such as mistrust in tool accuracy, limited prompting skills, and insufficient training hindered broader adoption. Tools were primarily used for document drafting, with limited exploration of advanced functionalities. Participants strongly emphasized the need for structured training programs and institutional support to enhance usability and confidence. Familiarity with technology, positive early experiences, and openness to innovation may facilitate adoption, while barriers such as limited knowledge, mistrust in tool accuracy, and insufficient prompting skills can hinder broader use. LLM AI tools are now primarily used for basic tasks such as document drafting, with limited application to more advanced functionalities due to a lack of training and confidence. Structured tutorials and institutional support are needed to enhance usability and integration. Targeted training programs, combined with organizational strategies to build trust and improve accessibility, could enhance adoption rates and broaden tool use. Future quantitative investigations should validate the adoption rate and influencing factors.

Background Cardiac rehabilitation (CR) is a prognostic management strategy to help patients with CVD achieve a good quality of life and lower the rates of recurrence, readmission, and premature death from disease. Globally, cardiac rehabilitation is poorly established in hospitals and communities. Hence, this study aimed to investigate the discrepancies in the perceptions of the need for CR programs and relevant health policies between directors of hospitals and health policy personnel in South Korea to shed light on the status and to establish practically superior and effective strategies to promote CR in South Korea. Methods We sent a questionnaire to 592 public health policy managers and directors of selected hospitals, 132 of whom returned a completed questionnaire (response rate: 22.3%). The participants were categorized into five types of organizations depending on their practice of PCI (Percutaneous Coronary Intervention), establishment of cardiac rehabilitation, director of hospital, and government's policy makers. Differences in the opinions between directors of hospitals that perform/do not perform PCI, directors of hospitals with/without cardiac rehabilitation, and between hospital directors and health policy makers were analyzed. Results Responses about targeting diseases for cardiac rehabilitation, patients’ roles in cardiac rehabilitation, hospitals’ roles in cardiac rehabilitation, and governmental health policies’ roles in cardiac rehabilitation were more positive among hospitals that perform PCI than those that do not. Responses to questions about the effectiveness of cardiac rehabilitation and hospitals’ roles in cardiac rehabilitation tended to be more positive in hospitals with cardiac rehabilitation than in those without. Hospital directors responded more positively to questions about targeting diseases for cardiac rehabilitation and governmental health policies’ roles in cardiac rehabilitation than policy makers, and both hospitals and public organizations provided negative responses to the question about patients’ roles in cardiac rehabilitation. Responses to questions about targeting diseases for cardiac rehabilitation, patients’ roles in cardiac rehabilitation, and governmental health policies’ roles in cardiac rehabilitation were more positive in hospitals that perform PCI than those that do not and public organizations. Conclusions Hospitals must ensure timely referral, provide education, and promote the need for cardiac rehabilitation. In addition, governmental socioeconomic support is needed in a varity of aspects.

Purpose - To improve health-care delivery from within, managers need to engage physicians in organisational development work. Physicians and managers have different mindsets professional identities which hinder effective communication. The aim of this paper is to explore how managers can transform this situation.Design methodology approach - The authors' interview study reveals physicians' own perspective on engagement for organisational improvement. They discuss identities from three theoretical perspectives and explore the mindsets of physicians and managers. They also explore the need to modify professional identities and how this can be achieved.Findings - If managers want physicians to engage in improvements, they must learn to understand and appreciate physician identity. This might challenge managers' identity. The paper shows how managers - primarily in a Swedish context - could act to facilitate physician engagement. This in turn might challenge physician identity.Research limitations implications - Studies from the western world show a coherent picture of professional identities, despite structural differences in national health-care systems. The paper argues, therefore, that the results can be relevant to many other health-care systems and settings.Originality value - The paper provides an alternative to the prevailing managerial control perspective. The alternative is simple, yet complex and challenging, and as the authors understand it, necessary for health care to evolve, from within.

The movement away from fee-for-service models to those that emphasize quality of care and patient outcomes affords a unique opportunity for antimicrobial stewardship programs to expand their value for hospital administration. Antimicrobial stewardship participants must collaborate with administrators and key stakeholders to position themselves to improve economic, process, and outcomes measures. This will allow the establishment of antimicrobial stewardship programs as essential components of the present and future healthcare quality journey.

To break their destructive antagonism over issues of health service modernisation, doctors and managers should engage more directly with nursing and allied health professionals when responding to reform initiatives