Accepted for/Published in: JMIR Medical Education
Date Submitted: May 14, 2025
Date Accepted: Apr 21, 2026
Development and Validation of Scale for Measuring Leadership and Managerial Competencies of Middle Managers in Healthcare and Medical Education in Gulf region: A cross-sectional study
ABSTRACT
Background:
The Kingdom of Saudi Arabia and the Kingdom of Bahrain are currently transforming their healthcare systems from a government system to a more self-sustained autonomous system. This goal requires effective leadership at all levels of management, especially at the middle management which is vital for effective planning and operative implementation.
Objective:
The aim of this study is to develop a feasible, reliable, and valid scale for measuring leadership and managerial competencies of middle managers in healthcare and medical education in the Kingdom of Saudi Arabia and the Kingdom of Bahrain.
Methods:
A mixed-methods approach was adopted for the study. Semi-structured interviews were conducted across three groups: Top Management (TM), Middle Management (MM), and Lower Management (LM) for creation of items for the scale (n = 27). Thematic analysis was used for analyzing the qualitative data. Two hundred and two participants from medical education (ME) and healthcare (HC) facilities responded to the new scale. Cronbach's alpha, exploratory and confirmatory factor analysis were performed to confirm the internal consistency and validity of the scale.
Results:
In its qualitative aspects, seven major themes emerged from thematic analysis. These were Personality, Agility, Attitude, Managerial Skills, Work Ethics, Mental Ability, and Interaction. A structural model with three interrelated constructs - “professionalism and problem-solving,” “team management and adaptation,” and “time management and expertise” were recognized based on factor analysis. A validated scale for measuring leadership and managerial competencies for middle managers in healthcare and medical education containing 12 characteristics and 17 competencies was the final outcome from the study.
Conclusions:
The “Leadership and Managerial Competency Scale for Middle Managers in Gulf Region (LMCS-MM Gulf Region)” developed under this study reflects what people in the three levels of management (lower, middle, and top) across ME and HC value in a middle manager. Keywords: leadership, managerial competency, medical education, healthcare, management, middle management, lower management, scale development, middle managers
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