Adopting an Integrative and Co-Design Process to Contextualize Management Capacity Building in Hospitals.

Introduction: Context plays a critical role in shaping how interventions are designed and implemented, and must therefore be considered prior to implementation. There is consensus that the relationship between contextual factors and intervention outcomes is best understood using qualitative and quantitative methods, the process for considering and incorporating context remains unclear. Drawing on a recently completed study focusing on building hospital management capacity, this paper describes and discusses the benefits and learning from the implementation of an integrative and co-design approach. Methods: This sequential mixed-methods study included managers and clinicians from two district hospitals in China. Focus Group Discussions [FGD] are a critical step in guiding the adaptation of several validated tools in the local hospital context. Data collected from FGDs and online surveys provides a comprehensive understanding of the current state of hospitals. Results: This study identified a wide range of difficulties faced by mid-level managers and clinical staff in two hospitals. While managers reported hospital-specific challenges, staff across both sites consistently cited issues such as inadequate support, lack of recognition, and lack of patient trust. Survey results also revealed low levels of psychological empowerment, job satisfaction, and perceived leadership effectiveness. Self-assessment using the MCAP tool highlighted significant competency gaps among mid-level managers, particularly in operations management and leading change. Discussion: The use of a co-design approach broadly engaging relevant key stakeholders from the design and implementation of the project and formulation of improvement strategies is key to enabling project success and maximizing and sustaining project impact.