Managerial perceptions of core competencies for healthcare middle managers in Bahrain and Saudi Arabia: a qualitative study.

Objectives: This study aimed to identify and compare the perceptions of senior, middle, and frontline managers regarding the core competencies required for effective healthcare middle managers in Bahrain and Saudi Arabia. It also explored how these competencies can inform competency-based leadership development programs globally. Methods: A qualitative descriptive design was adopted. Twenty-seven participants from healthcare and medical education institutions in Bahrain and Saudi Arabia were purposively selected across three hierarchical levels: senior (n = 6, 22%), middle (n = 10, 37%), and frontline (n = 11, 41%). Semi-structured interviews were conducted virtually, audio-recorded, transcribed verbatim, and analyzed thematically using Braun and Clarke's six-step framework. Credibility was strengthened through member checking, peer debriefing, and an audit trail. Results: Five overarching competency domains emerged in the study. They include personality, managerial skills, work ethics, mental ability and interaction. Personality, integrity, and organizational ability were the most frequently cited traits (93%). Managerial and social competencies such as time management (90%), teamwork (83%), communication (70%), and decision-making (60%) were emphasized across all managerial levels. Senior managers prioritized strategic agility and ethics, whereas frontline managers stressed interaction and communication. These patterns reflect the dual operational and relational demands of middle management in healthcare. Conclusions: Successful healthcare middle managers require a balanced integration of technical proficiency, ethical integrity, interpersonal competence, and adaptability. Embedding these domains into competency-based leadership training could enhance organizational performance and strengthen healthcare governance across the region.