Purpose Hospitals, as social institutions that provide health services to the community under its coverage, are one of the pioneer institutions that encourage and use social participation in the management and implementation of public governance. The leading countries in hospital quality improvement and management have generally moved towards models of hospital administration under public guidance and supervision or so-called public governance. This research will be carried out to provide a public governance model for Iran's hospitals, focusing on the management of hospitals with the participation of the people. Design/methodology/approach This research followed a mixed-method design to develop a public governance model for hospitals in Iran. First, the components of public governance for hospitals in Iran are identified by reviewing the literature and experiences of other countries, and then, the viewpoints of experts regarding the components of public governance for hospitals in Iran are collected through qualitative methods such as focus group discussion and interviews. Based on the findings of the literature review and qualitative methods, the initial model of the public governance model for hospitals in Iran will be developed, validated and finalized using the Delphi technique. Finally, the evaluation indicators of the designed model will be extracted. Findings The results of this research will provide policymakers and senior managers of the health system with valuable information to improve the performance of the public governance system in the health system of the country. To achieve this goal, the comprehensive evaluation tools are required. Research limitations/implications This study protocol may face limitations in its applicability to healthcare systems outside Iran due to differences in organizational, cultural and political contexts. The qualitative methods and Delphi technique, while ensuring depth and expert input, might lead to subjective interpretations and potential biases in the final model. Additionally, the reliance on expert consensus may not fully capture all stakeholder perspectives. Future research will need to validate the proposed model in diverse healthcare settings and incorporate a broader range of stakeholders to ensure its generalizability and impact on global healthcare governance practices. Practical implications This study will provide a comprehensive framework for implementing public governance in Iranian hospitals, emphasizing stakeholder participation and transparency in decision-making. The proposed model, once validated, can serve as a practical tool for policymakers and hospital administrators to enhance accountability, optimize resource allocation and improve service quality. By introducing clear evaluation indicators and implementation guidelines, the study aims to address existing management challenges and align hospital operations with public expectations. The findings will offer actionable insights that can be adapted to similar contexts, contributing to the development of more effective and equitable healthcare management practices. Social implications The proposed study will have significant social implications by introducing a governance model that prioritizes inclusive and participatory decision-making in hospital management. By involving various stakeholders, including patients and community representatives, the model aims to foster greater public trust and accountability. Its implementation will likely lead to improved healthcare service quality, equitable access and enhanced satisfaction among users. This participatory approach is expected to contribute to more sustainable healthcare systems, promote social justice and address disparities in healthcare delivery, ultimately benefiting broader society by aligning governance practices with public welfare and shared responsibilities. Originality/value This study contributes to the advancement of healthcare governance by proposing a novel public governance model for hospital management, integrating the perspectives of multiple stakeholders. Unlike traditional models, this approach emphasizes stakeholder collaboration, transparency and accountability to enhance service quality and satisfaction. By employing systematic, qualitative and Delphi methodologies, the study identifies and prioritizes comprehensive evaluation indicators tailored to the healthcare context. The findings offer valuable insights for policymakers, hospital managers and researchers seeking innovative strategies to address governance challenges in the health sector, ultimately fostering sustainable and people-centered healthcare systems.

Purpose Primary healthcare serves as the first point of access to medical services for the general population. As newer primary healthcare systems emerge, they often take time to refine their governance structures to maximize population health outcomes aligned with the quadruple aim. This study aims to explore and share learnings on how governance structures influence the performance and success of primary healthcare systems in respect to Ontario, Canada. Design/methodology/approach We conducted an analysis of the governance structures of several successful healthcare systems around the world. The study focused on identifying core governance functions—such as priority setting, performance monitoring, and accountability—that contribute to the effectiveness of these systems. Findings Our analysis suggests that successful health systems are typically rooted in governance frameworks that emphasize clear priority setting, continuous performance monitoring, and mechanisms for accountability. These elements appear to be critical in enabling healthcare systems to achieve better population health outcomes. Originality/value This commentary contributes to the literature by synthesizing governance strategies from high-performing global health systems and offering targeted recommendations for developing primary healthcare systems. The findings provide practical guidance for policymakers seeking to enhance governance to meet the quadruple aim.

Purpose Patient experience is commonly assessed through surveys that measure health gains and perceptions of episodes of care. This approach reveals fatigue and falling response rates, indicators of misalignment between patients and healthcare providers. This study proposes to broaden the patient experience perspective beyond episodes. By assuming a patient journey in which digital technology is increasingly prominent, this study aims to identify the capabilities that healthcare provider organisations should develop to enhance patient experience. Design/methodology/approach The study employed a structured six-step process of thematic analysis within a qualitative research design. Data were collected through semi-structured interviews with healthcare executives from 11 countries. The data were thematically coded using MAXQDA software. To reinforce reliability, the triangulation for convergence technique was applied using data from 88 abstracts published during 2023 and 2024. This secondary data from 21 countries corroborated the findings. Findings Grounded in the theories of structuration and dynamic capabilities, the study proposes the Honeycomb capabilities framework and develops six propositions. This framework contributes to the management of healthcare provider organisations by identifying key capabilities to enhance patient experience. The study formulated implications for research, practice and society. Research limitations/implications CX in healthcare is not PX. The two concepts have different roots in literature and practice and should not be used interchangeably. PX concept extension is necessary in scope and measurements to align practice with praxis. This study reinforces the thesis from Seidl and Whittington (2014) that the SAP research agenda should be enlarged and interplay with other research streams. Practical implications Managers should assume responsibility and be accountable for PX. PX is not a departmental function but an HCPO mission. HCF can be a roadmap to develop dynamic capabilities at the top management level. Social implications Many of the benefits of prominent public policies, such as open data policies or common data spaces, depend on patients’ behaviours, including adoption, engagement, altruism, consent or choices. In turn, these behaviours require a positive PX, which relies on HCPOs and the patient’s relationship. Originality/value This study proposes a novel approach to patient experience by augmenting its scope beyond the patient encounters. The finding suggests that healthcare managers are accountable for developing specific dynamic capabilities to succeed. The study design, grounded in cross-country evidence, facilitates the generalisation.

Purpose This article interrogates the persistent contradictions in global health governance between neoliberal, market-oriented approaches and the universal right to health. It seeks to clarify how key global actors promote equity in principle while advancing market-driven frameworks that commodify healthcare. Design/methodology/approach The study adopts an interpretive and conceptual research design, relying exclusively on secondary sources, including academic literature, institutional reports and global policy documents. While adopting interpretive research design, the article's value lies in synthesising diverse strands of literature and practice into a cohesive conceptual framework, offering an agenda-setting contribution that complements ongoing empirical studies. Findings The article finds that rights-based frameworks risk fiscal overextension if detached from sustainable financing, while market mechanisms can stabilise provision but only by narrowing access and institutionalising inequity. These unresolved trade-offs, between equity and sustainability, universality and scarcity, constitute the central governance dilemma. Originality/value This article contributes a cohesive conceptual framework that integrates fragmented debates on health rights and neoliberal governance. By reinterpreting global health through the lens of governance trade-offs, it advances an agenda-setting perspective for reform.

Purpose This paper aims to investigate how retirement and its duration affect functional health, using grip strength as an early biomarker of ageing. It examines the implications of pension policy and cultural context for physical functioning among older adults in Europe. Design/methodology/approach We analyse panel data from the Survey of Health, Ageing and Retirement in Europe, covering 2004–2019. A fixed effects instrumental variable (FE–IV) approach is employed, using eligibility for state pension age as an exogenous instrument to address endogeneity in retirement status. Findings Retirement improves grip strength, particularly among older women and in individualistic welfare regimes. However, extended time in retirement leads to functional decline, especially among men and in collectivist societies. These patterns suggest both health-promoting and health-risk phases within retirement, shaped by policy and cultural environments. Originality/value By linking pension eligibility rules with functional health outcomes across countries, this study provides governance-relevant evidence for designing retirement systems that support healthy ageing. Findings highlight the need for integrating physical resilience programs within retirement policy, tailored to national contexts and cultural norms, to reduce long-term health risks and promote equity in ageing.

Purpose Prevention and detection of cyber threats in health care is known to be suboptimal, yet even less attention has been paid to building resilience and developing incident response and recovery plans for situations when disruptive cyber attacks such as ransomware or terrorist events, occur. Recognising this, the World Health Organization has called for the development of guidance on clinical incident response planning that addresses how health care organisations should respond to cyber attacks. Design/methodology/approach In this narrative review, we present key strategic and policy frameworks as well as recommendations and shared experiences from the literature to help health organisations build cybersecurity preparedness and resilience. On 30th April 2025, we searched without date, language or geographical restrictions in PubMed, Web of Science, Scopus, IEEE Xplore and EBM Reviews. A total of 51 relevant documents were included in the review. Findings Careful advance planning, practicing and training in the form of tabletop scenarios or simulations, and implementing the principles of gamification can markedly reduce the disruptive impact of realised threats. Approaches to cybersecurity preparedness and resilience must be proactive and led by dedicated, certified teams, fully supported by top executives and enabled by compliance across staff. Pre-planning for efficient communication is needed not only within the targeted health care organisation but also across the health care sector and between sectors. Originality/value An overview of the current best evidence to inform efforts towards strengthening cybersecurity preparedness and resilience in health care organisations.

Purpose This study highlights how socio-demographic, non-medical and medical factors play a different role in the health satisfaction among people between Asian countries and non-Asian countries. Design/methodology/approach This study employs the hierarchical linear regression. Findings All medical factors play an important role in health satisfaction across all categories and countries, with the exception of practitioners in Asian countries. Second, non-medical factors have a more pronounced role in health satisfaction in Asian countries than in non-Asian countries. Third, socio-demographic factors exert a greater influence on health satisfaction within healthcare systems in Asian countries, whereas they have a more significant impact on practitioners in non-Asian countries. Fourth, gender, education and weight consistently affect health satisfaction across all categories in Asian countries, while their influence is less pronounced in non-Asian countries. Originality/value This study underscores the necessity for health policymakers and practitioners to account for regional differences in the determinants of health satisfaction.

Purpose Notwithstanding increased patient safety initiatives, adverse events and their impact on those involved continue. The strategic approaches adopted to manage safety by other high-intensity, high-risk and complex industries, such as aviation, have led to an increase in the systems approach for safety management in healthcare organisations. Professional expertise from members of the European Researchers’ Network for Second Victims (ERNST) highlighted that safety and the second victim phenomenon are interconnected across the healthcare ecosystem, extending beyond individual healthcare organisations. Design/methodology/approach Evidence from different sources, mainly the literature and practitioner professional expertise, was iteratively aggregated and analysed using theoretical systems-based approaches to conceptualise a framework for integrated safety in safety management systems in health. Findings A cross-sectional view of the healthcare organisation affected by adverse events was presented as a baseline. The whole system (system levels) approach, representing the healthcare system at the micro-, meso- and macro-level, adapting the model for integrated care, was then adopted. A safety-generating culture was considered to integrate and network across the levels of the healthcare system. The “system” (processes) approach, also considering external factors, was incorporated. This iterative conceptualisation led to a proposed framework for integrated safety. This framework was applied to systematically make recommendations for actions to support safety across the healthcare ecosystem. Originality/value Aggregation of evidence from the literature, together with expertise from professionals and iterative conceptualisation across models adopting the systems approach, led to a comprehensive framework for integrated safety in safety-management systems.

Purpose The study used the convergence test to revisit the disparities in per capita healthcare expenditure and prescription drug spending over time across the 50 US states and the District of Columbia. Design/methodology/approach We employed cross-state balanced panel data covering the period 1980–2020, which yielded 2,091 observations and was estimated using the club convergence test. Findings The results reveal widening disparities in per capita healthcare expenditure and prescription drug spending across US states and the District of Columbia. Further analysis using club convergence tests shows that per capita healthcare expenditure exhibits two convergence clubs and one divergence group. In comparison, per capita prescription drug spending exhibits three convergence clubs. Despite the lack of full convergence in healthcare expenditure and prescription drug spending, states with similar characteristics are converging, and there is a possibility of converging to different equilibria where the disparity in per capita healthcare expenditure and prescription drug spending decreases over time. Other results suggest that the formation of club convergence in per capita healthcare expenditure can be attributed to per capita income (measured by per capita gross domestic product), population growth and the unemployment rate. In contrast, population growth and unemployment affect club formation in per capita spending on prescription drugs. Originality/value First, we extended the data from previous studies. Second, unlike these studies, we examine the macroeconomic determinants of the convergence of healthcare and prescription drug spending.