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Despite the advent of New Public Management theories over three decades ago, doubts persist regarding the practical implementation of these principles in the public health-care context. Challenges arise particularly from the type of system where this phenomenon is analyzed. In the Italian context, for instance, it can be arduous to define universally applicable organizational behaviors, given the interregional disparity that characterizes such a system. Furthermore, the professional identity of clinician-managers influences the perception of what “being a manager” means. This paper, thus, using the Italian context as a reference, aims to delineate what is the perception of Italian public hospitals clinician-middle-managers in terms of their responsibilities and tasks.

A survey-questionnaire was distributed to 6,011 Chief Medical Officers (CMOs) in Italian public hospitals, representing 100% of such role holders in the country. With a response rate of 16.7%, 1,005 responses were obtained. The questionnaire assessed CMOs' attitudes toward specific activities relevant to clinician-management, ranked from most to least important. Activities were derived from literature and categorized to discern management styles. Subgroups based on geographical location and professional orientation were also identified to isolate regional effects and professional identity influences.

Results suggested that activities associated with a collaborative approach are perceived as most important. Furthermore, it clearly emerges the difference based on professional orientation of CMOs. However, it could not be appreciated the same level of difference basing the analysis on regional disparities.

The interest in the role of middle management in healthcare organizations has increased over the years. Nevertheless, currently the authors believe that not many studies are focused on defining what “being a manager” means for clinician-managers themselves, rather than explaining what clinician-managers shall do.

The purpose of this paper is to understand whether and how the Environmental, Social and Governance (ESG) paradigm can be useful in social reporting in the context of nonprofit healthcare organizations. In other words, the study deals with non-financial reporting and information, allowing external stakeholders to comprehensively evaluate the organization’s performance and behavior, investigating internal stakeholder perception over ESG paradigm application.

The authors used a case study approach investigating four cases among nonprofit healthcare organizations in Italy. Analyses of available primary sources have been conducted, followed by semi-structured interviews. Interviews were then transcribed and coded in a joint blinded process by all authors. More specifically, three areas have been investigated: (1) factors motivating the development of non-financial disclosure practices; (2) the rationale behind the organization’s decision to include specific topics; and (3) the future perspective on the future of non-financial disclosure within the specific sector.

ESG may serve as a suitable framework to create comparable documents that can act as benchmarks for similar institutions. However, while nonprofit organizations (NPOs) can draw inspiration from ESG, the utility of these criteria should be thoughtfully tailored to align with the organization’s mission. The ESG using as a general guide, instead of implementing it as a real tool to assess performances, emerges as a positive practice. NPOs should not focus on fulfilling ESG requirements bur rather take inspiration from them. Otherwise, the risk is an excess of focus on the formal aspect rather than on its content.

The study contributes to a better understanding of social and ESG’ reporting activities and approaches in the healthcare sector by describing some case studies and the effect of sustainability in the social reporting of nonprofit healthcare organizations.

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

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

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

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

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

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