Middle managers' perspectives on social and technical demands and resources in hospital management: an integrated STS–JD-R approach

Purpose This study explores how middle-level hospital managers perceive key organizational and human challenges and propose solutions within a complex healthcare environment. It applies a combined Socio-Technical Systems (STS) and Job Demands–Resources (JD-R) perspective to examine how social and technical factors interact in shaping sustainble hospital management. Design/methodology/approach A qualitative design was used. Ninety-four middle-level managers from a large Lithuanian hospital completed an online survey with two open-ended questions about organizational challenges and suggested solutions. Responses were analysed using deductive thematic analysis guided by predefined STS and JD-R categories, supplemented by content analysis to quantify the frequency of social and technical demands and resources. Findings Managers described considerably more technical than social demands, highlighting financial constraints, staffing shortages, workflow inefficiencies, and fragmented digital infrastructure. Social demands included communication difficulties, teamwork issues, psychological strain, and resistance to change. Proposed solutions reflected a balance of social and technical resources, such as strengthening communication, enhancing collaboration, improving IT systems, increasing training, and providing time and information to support change. The findings show that managers view technical efficiency and staff well-being as interdependent components of sustainable hospital functioning. Practical implications The findings highlight areas that hospitals may consider when strengthening management practices, including clearer communication, more coherent digital and organizational processes, and supportive training to help staff adapt to change. Originality/value This study applies an integrated STS–JD-R framework to examine how middle-level managers describe social and technical demands and the resources they consider necessary to address them, offering a structured way to interpret managerial sense-making in hospital settings.