Development and Validation of a Scale for Measuring Leadership and Managerial Competencies of Middle Managers in Health Care and Medical Education in the Gulf Region: Cross-Sectional Study

Abstract Background The Kingdom of Saudi Arabia and the Kingdom of Bahrain are transforming their health care systems toward more self-sustained, autonomous systems. Effective leadership at all management levels, particularly middle management, is critical for operational success. Objective The study aimed to develop a feasible, reliable, and valid scale for measuring leadership and managerial competencies of middle managers in health care and medical education in the Gulf region. Methods A mixed methods approach was adopted. Semistructured interviews were conducted with top management, middle management, and lower management staff (N=27). Reflexivity of coders and thematic saturation were considered to ensure the reliability and transparency of qualitative findings. Thematic analysis informed scale item creation. A total of 202 participants from medical education and health care sectors completed the scale. Cronbach α, exploratory factor analysis (principal axis factoring), and confirmatory factor analysis validated internal consistency and factor structure. Responses marked as “6=unable to assess” were treated as missing data during quantitative analysis. Results Seven themes emerged: personality, agility, attitude, managerial skills, work ethics, mental ability, and interaction. Three constructs were identified: professionalism and problem-solving, team management and adaptation, and time management and expertise. A validated scale with 17 competency measure points and 16 characteristic items was finalized. Only competency measure points underwent exploratory factor analysis and confirmatory factor analysis, while characteristic items were retained for descriptive evaluation. Conclusions The Leadership and Managerial Competency Scale for Middle Managers in the Gulf Region reflects perceived competencies valued at all management levels. The scale measures perceived importance, not actual performance; the conclusions align with the validated scope.