Leadership competence and perceived value-based healthcare implementation through change management and employee engagement in a Saudi health cluster

This preprint examines the relationship between leadership competence and perceived value-based healthcare (VBHC) implementation, with change management and employee engagement as concurrent mediating variables, in Madinah Health Cluster, Saudi Arabia. A quantitative, cross-sectional, web-based survey was conducted among 429 clinical and administrative employees. The data were analysed using partial least squares structural equation modelling (PLS-SEM) in SmartPLS 4, with 5,000 bootstrap resamples to assess five direct and two specific indirect associations. The findings indicate a positive direct association between leadership competence and perceived VBHC implementation (β = 0.331), alongside positive indirect associations through change management (β = 0.124) and employee engagement (β = 0.401). The model explained 81.8% of the variance in perceived VBHC implementation. The findings highlight the potential relevance of leadership competence, organizational change processes, and workforce engagement to healthcare transformation. However, the cross-sectional, single-source design, non-probability sampling, and concerns regarding construct distinctiveness limit the interpretation and generalisability of the findings.