Management and Leadership in Healthcare: Expectations, Conditions, Skills, and Reflections in a Leadership Program

The aim of this study is to describe and compare first- and second-line managers' expectations, skills, and conditions for practicing management and leadership before, during, and after participation in a leadership development program, as well as their reflections on the program.

Approximately 50 first- and second-line healthcare managers participating in a leadership development program will be followed from autumn 2026. Data will be collected through questionnaires, diary entries, and focus group interviews.

A web-based questionnaire will be administered before the program, immediately after completion, and one year after completion. The questionnaire will collect demographic information and data on the managers' self-rated management and leadership using the Leadership and Management Inventory, LaMI-II, and on thriving, understood as flourishing and developing positively, using the Thriving Scale. Study-specific questions will also address whether participants have considered leaving or have left their current management position.

During the leadership development program, participants will be asked to use diaries to describe their expectations of the program and to reflect on learning, insights, application, conditions for participating in the program, and conditions for practicing management and leadership.

After completion of the leadership development program, focus group interviews will be conducted with 5-7 participants in each group. The interviews will be based on the participants' collective descriptions in the diary entries.

Questionnaire data will be compared longitudinally using statistical tests appropriate to the level and distribution of the data. Diary entries and focus group interviews will be analyzed using qualitative content analysis. The quantitative and qualitative results will then be integrated to provide a deeper understanding of the managers' development, experiences, and conditions before, during, and after participation in the leadership development program.

• Leadership Development Program (Behavioral): An established leadership development program provided annually by a Swedish healthcare region for first- and second-line managers. The program includes planned learning activities, reflection, and interaction intended to support participants in developing their management and leadership practice. The healthcare organization selects participants and provides the program independently of the research study. The research team does not assign participants to the program or determine its content or delivery.

Primary outcomes

• Self-rated management and leadership performance [Before the leadership development program, immediately after program completion, and 12 months after program completion]: Self-rated management and leadership performance will be assessed using the Leadership and Management Inventory-II (LaMI-II). The instrument consists of 25 items divided into two factors: management and leadership. Each item is rated on a five-point scale ranging from 1 (not at all) to 5 (to a very large extent). Scores will be calculated for the management factor, the leadership factor, and the total scale. Raw scores will be transformed to values ranging from 20 to 100 by dividing the sum of the item scores by the highest possible score and multiplying by 100. Higher scores indicate more desirable self-rated management and leadership performance. Changes in management, leadership, and total scores will be examined over time. Scores may also be compared within the study group according to demographic and work-related characteristics and whether participants have considered leaving or have left their current management position.
• Thriving at work [Before the leadership development program, immediately after program completion, and 12 months after program completion.]: Thriving at work will be assessed using the 10-item Thriving Scale. The scale consists of two factors: learning and vitality, with five items representing each factor. Each item is rated on a seven-point scale ranging from 1 (totally disagree) to 7 (totally agree). Mean scores will be calculated for the learning factor, the vitality factor, and the total scale. Higher scores indicate a higher degree of thriving at work, understood as the joint experience of learning and vitality. Changes in learning, vitality, and total thriving scores will be examined over time. Scores may also be compared within the study group according to demographic and work-related characteristics and whether participants have considered leaving or have left their current management position.
• Healthcare Managers' Reflections on the Leadership Development Program [From the beginning of the leadership development program until completion of the focus group interviews, approximately September 2026 to September 2027]: Participants' reflections on the leadership development program will be explored through structured diary entries completed during the program and through focus group interviews conducted after program completion. The diary entries will address participants' expectations of the program and their reflections on learning, insights, application of program content, conditions for participating in the program, and conditions for practicing management and leadership. The focus group interviews will explore these areas in greater depth and will be informed by the participants' collective diary reflections. Diary entries and transcribed focus group interviews will be analyzed using qualitative content analysis. The outcome will consist of categories describing participants' expectations, experiences, learning, application, and perceived conditions related to the leadership development program and their management and leadership practice.

Secondary outcomes

• Intention to Leave or Having Left the Current Management Position [Immediately after completion of the leadership development program and 12 months after program completion]: Participants will be asked whether they have considered leaving their current management position or have left the position. The study-specific questionnaire responses will be described and may also be used to compare self-rated management and leadership and thriving scores within the study group.

Sex: All

Inclusion Criteria:

* Employed as a first- or second-line healthcare manager in Region Kronoberg and selected by the healthcare organization to participate in the leadership development program starting in September 2026.

Exclusion Criteria:

* Not employed as a first- or second-line healthcare manager