Middle managers’ views on organizational health literacy in Italian public university hospitals

Background

Organizational health literacy (OHL), is defined as the extent to which healthcare organizations implement policies, practices, and systems that make it easier for people to navigate, understand, and use information and services. The aim of this study was to assess how OHL is perceived within complex academic hospitals by middle managers.

Methods

A cross-sectional survey was conducted (June 2024–January 2025) in three Italian public university hospitals. All clinician-managers with formal coordination/leadership roles were invited. The questionnaire collected professional data, perceived quality of non-clinical service aspects influencing the care process and patient relationship, and the validated Italian HLHO-10 instrument. An exploratory factor analysis assessed the HLHO-10 structure.

Results

Fifty-four participants completed the survey (59% male; mean age 55.6±8.9 years). Exploratory factor analysis identified two components explaining 69.6% of the total variance: communication and information practices supporting patient orientation and understanding (mean 4.74±1.64; α = 0.887) and strategic governance orientation toward HL (mean 3.74±1.94; α = 0.922). Both components were positively correlated with perceived non-clinical service quality. The governance-oriented component remained independently associated with higher perceived service quality (OR = 1.77; 95% CI 1.14–2.75).

Conclusions

Middle managers perceived a gap between operational communication practices and the strategic integration of OHL within hospital governance. While elements of OHL are present in some Italian academic hospital settings, their integration within institutional governance and organizational policy remains uneven. Strengthening the strategic embedding of HL within leadership priorities, quality management systems, and staff development may support more coherent approaches to patient-oriented communication and service organization.

Key messages

• Organizational health literacy initiatives may be perceived as more effective when they are embedded in institutional policies, leadership mandates, and quality management systems.

• Middle managers represent a critical leverage point for translating strategic health literacy commitments into sustainable organizational practice in complex hospital settings.