Generosa Do Nascimento

Public sector organizations face persistent challenges in workforce retention, particularly in institutionally complex and resource-constrained environments. Although leadership is widely recognized as a key factor, research remains fragmented across the public administration and human resource management literature. This article develops a governance-sensitive framework to explain how leadership influences workforce retention in public service organizations. Drawing on a PRISMA 2020-guided systematic review of 30 studies, it integrates insights to examine the relationships between people-centered leadership, organizational commitment, and turnover intentions. The synthesis suggests that leadership effects are primarily indirect, operating through affective organizational commitment. Administrative burden (red tape) and working conditions emerge as key contextual factors shaping these relationships. The study contributes by offering an integrated framework and identifying implications for managing workforce retention in public healthcare organizations and comparable institutionally dense public service settings. The article proposes an integrated conceptual framework for future empirical research.

Background: Public healthcare systems face persistent workforce retention challenges that undermine service continuity, organizational resilience, and public value creation. Although leadership is frequently identified as a relevant lever, the literature remains theoretically fragmented and often treats leadership effects as direct and context-free. Methods: This review adopts a PRISMA-guided systematic literature review as a theory-building strategy. Searches were conducted in Web of Science, Scopus, and PubMed using combinations of terms related to leadership, organizational commitment, job satisfaction, turnover intention, and retention in healthcare settings. The review identified 640 records, removed 372 duplicates, screened 268 titles and abstracts, assessed 90 full-text records for eligibility, and retained 30 peer-reviewed studies for configurative synthesis. The analysis combined thematic synthesis with configurative mapping to identify mechanisms, recurring patterns, and contextual contingencies. Results: The review shows three consistent patterns. First, leadership is linked to retention predominantly through organizational commitment, especially affective and normative commitment, rather than through direct effects. Second, institutional and organizational conditions—particularly red tape and working conditions—shape the strength of leadership–commitment relationships. Third, workforce heterogeneity, including generational differences, affects how leadership practices and organizational environments are interpreted, although these dynamics are rarely theorized explicitly in the literature. Conclusions: The article develops a governance-sensitive integrative framework in which people-centered leadership influences turnover intentions indirectly through organizational commitment, while red tape and working conditions operate as contextual moderators. By embedding leadership within Public Administration and governance theory, the review clarifies the literature’s main explanatory gap and provides a foundation for comparative empirical testing and for more sustainable workforce strategies in public healthcare systems.

The integration of health and social care is increasingly recognized as essential to address population ageing, the rise in chronic diseases, and persistent health inequities. Across Europe, diverse models have been developed to improve service coordination, resource efficiency, and person-centered care. This paper aims to explore international experiences in integrating health and social care, identify common strategies and challenges, and provide insights to inform policy development in countries where integration remains incipient, with a focus on Portugal. A qualitative comparative approach was employed. A systematic literature review was conducted across PUBMED, MEDLINE, and Google Scholar, including peer-reviewed articles, policy reports, and government documents. Thematic analysis was used to identify integration models, enablers, and barriers across different countries. Different models reveal that joint governance, pooled funding, strong community involvement, and digital innovation are key enablers of integration. However, common challenges persist, including fragmented governance, inconsistent implementation, and financial sustainability. In Portugal, structural separation between the health and social sectors continues to limit strategic alignment. Successful integration depends on political commitment, shared vision, and active stakeholder collaboration. European models offer adaptable lessons for Portugal and similar systems, especially regarding intersectoral coordination and preventive care. Integrating health and social care is vital for building resilient, equitable systems. Portugal must adopt a cohesive national strategy; strengthen local implementation; and embrace person-centered, sustainable solutions to ensure long-term impact. Integrating the health and social sectors is indispensable in navigating the ever-evolving healthcare landscape and promoting holistic well-being.

The integration of health and social care has been a key focus in Scotland, driven by demographic changes, rising healthcare costs, and the need for more efficient service delivery. The Public Bodies (Joint Working) (Scotland) Act 2014 sought to formalise this integration by restructuring governance and service provision to improve coordination between health and social care sectors. Despite these efforts, challenges remain in fully achieving the intended outcomes of the integration. This study analysed Scotland’s integrated health and social care through the theoretical frameworks of public choice, institutionalism, and functionalism. The objective was to examine policy drivers, structural mechanisms, and governance implications, providing insights into the broader impact of integrated care reforms. A qualitative research approach was employed, synthesising data from peer-reviewed literature, government publications, and policy documents. The findings on integration were systematically examined through the lens of each public policy model, allowing for a nuanced analysis of how Scotland’s approach to integration aligns with and diverges from these frameworks. A literature search was performed on PUBMED, Google Scholar, and Scottish government portals. While integration improved coordination and service delivery in some areas, limitations in funding allocation, workforce distribution, and governance autonomy limited its overall success. Scotland’s integrated care model demonstrates potential benefits in reducing service fragmentation and improving patient-centred care; however, persistent challenges such as funding constraints, workforce shortages, and governance conflicts indicate that integration alone is not sufficient to resolve systemic healthcare inefficiencies. This study provides a perspective on Scotland’s health and social care integration, offering valuable lessons for other European countries facing similar demographic and healthcare challenges.

Introduction: With the growing development and adoption of artificial intelligence in healthcare and across other sectors of society, various user-friendly and engaging tools to support research have emerged, such as chatbots, notably ChatGPT. Objective: To investigate the performance of ChatGPT as an assistant to medical coders using the ICD-10-CM/PCS. Methodology: We conducted a prospective exploratory study between 2023 and 2024 over 6 months. A total of 150 clinical cases coded using the ICD-10-CM/PCS, extracted from technical coding books, were systematically randomized. All cases were translated into Portuguese (the native language of the authors) and English (the native language of the ICD-10-CM/PCS). These clinical cases varied in complexity levels regarding the quantity of diagnoses and procedures, as well as the nature of the clinical information. Each case was input into the 2023 ChatGPT free version. The coding obtained from ChatGPT was analyzed by a senior medical auditor/coder and compared with the expected results. Results: Regarding the correct codes, ChatGPT’s performance was higher by approximately 29 percentage points between diagnoses and procedures, with greater proficiency in diagnostic codes. The accuracy rate for codes was similar across languages, with rates of 31.0% and 31.9%. The error rate in procedure codes was substantially higher than that in diagnostic codes by almost four times. For missing information, a higher incidence was observed in diagnoses compared to procedures of slightly more than double the comparative rates. Additionally, there was a statistically significant excess of codes not related to clinical information, which was higher in procedures and nearly the same value in both languages under study. Conclusion: Given the ease of access to these tools, this investigation serves as an awareness factor, demonstrating that ChatGPT can assist the medical coder in directed research. However, it does not replace their technical validation in this process. Therefore, further developments of this tool are necessary to increase the quality and reliability of the results.

This research aimed to study the effect of leadership (transformational and transactional) on turnover intentions and whether this relationship is mediated by organisational commitment and moderated by the department of activity. To this end, it was hypothesized that: (1) leadership has a negative and significant association with turnover intentions; (2) leadership has a positive and significant association with affective organisational commitment; (3) organisational commitment has a negative and significant association with turnover intentions; (4) organisational commitment has a mediating effect on the relationship between leadership and turnover intentions; (5) the department to which the employee belongs has a moderating effect on the relationship between leadership and organisational turnover intentions. The sample consists of 477 participants working at the Hospital Professor Doutor Fernando Fonseca (HFF) in Portugal, performing their functions in several departments. This is a quantitative, correlational, and cross-sectional study. The results indicate that transformational leadership has a negative and significant effect on turnover intentions and a positive and significant effect on affective and normative commitment. Transactional leadership negatively and significantly affects all three components of organisational commitment. Affective and normative commitment has a negative and significant effect on turnover intentions. Calculative commitment has a positive and significant effect on turnover intentions. Affective commitment and calculative commitment have a partial mediating effect on the relationship between transformational leadership and organisational turnover intentions. The department to which the employee belongs does not have a moderating effect on the relationship between leadership and turnover intentions. It has been proven that leadership plays an extremely important role in the smooth running of this hospital unit.

A Avaliação de Desempenho Docente é um importante instrumento para escolas e professores, pois promove o desenvolvimento profissional, a motivação do corpo docente e a reflexão sobre a prática. Entendendo que o desempenho dos professores pode ser afetado por diversos fatores, este estudo teve como objetivo investigar o impacto do stress/saúde e qualidade de vida sobre a atividade docente. Para tal, foram realizadas entrevistas com 30 professores de duas instituições de ensino particular em Portugal e no Brasil. A partir das respostas, foram criadas categorias à luz da Análise de Conteúdo. Os resultados indicam que a maioria dos professores, 27 dos entrevistados, reconhece o impacto que o stress provoca em suas práticas e, sinaliza que o trabalho (nove professores) e a indisciplina dos alunos (14 professores) são os principais agentes desencadeadores de perda de qualidade de vida. Sendo assim, este estudo contribui para uma reflexão sobre a importância de se pensar estratégias para a melhoria da qualidade de vida dos professores

Este artigo é parte da dissertação de mestrado cujo objeto de estudo foi a Avaliação de Desempenho Docente, através de uma análise comparativa entre duas instituições de ensino particular, uma localizada em Portugal e outra no Brasil. A Avaliação de Desempenho Docente é um importante instrumento, para as escolas e para os professores, pois promove o desenvolvimento profissional, a motivação do corpo docente e conduz à reflexão, à melhoria do desempenho dos professores e da qualidade do ensino. Para o efeito foram realizadas entrevistas com professores para investigar o impacto do uso de tecnologias no desempenho docente. A maioria dos entrevistados percebe a importância da tecnologia para suas práticas e, ambas instituições incentivam seu uso por considerarem que facilita o desempenho do professor e a aprendizagem dos alunos.

Objective: To determine to what extent patient health status and recovery in post-acute care organizations (PACO) is related to patient experience of the discharge process from hospital and to patient experience while staying in these facilities. Design: Longitudinal study of patients discharged from hospitals to PACO. Setting: 12 hospitals and 14 PACO Portuguese organizations. Participants: 181 patients participated in the both stages of data gathering. Main Outcome Measures: Patients’ physical and mental health status was measured through the 36-item short form health survey scale. The experience of transition from hospital to PACO was measured with the Care Transition Measure. The Picker Adult In-Patient Questionnaire was used to measure patients’ experience in these organizations. Results: Patients reporting better physical condition in PACO had a better experience on discharge [b = 0.21, 95% confidence interval, CI (0.10, 0.31)] and perceive fewer problems inside facilities [b = − 0.19, 95% CI (−0.31, 0.08)]. The experience in PACO is significantly related to patients’ mental health status [b = − 0.47, 95% CI (−0.59, − 0.36)]. Patients showing higher levels of physical recovery had a better experience on discharge [b = − 0.18, 95% CI (0.08, 0.28)], while those registering better mental recovery experienced fewer problems during their stay [b = − 0.41, 95% CI (−0.52, − 0.30)]. Conclusions: PACO play a key role in maintaining and promoting patients’ health, and this goal is influenced by their experience both in the transition from hospitals to PACO and while staying in these facilities.