Digital Transformational Leadership and Coordinated Care in European Primary Healthcare: The Mediating Role of Patient Agility.

PURPOSE: This study aims to examine how digital transformational leadership (DTL) is associated with coordinated care (CR) in primary healthcare organizations, with particular focus on the mediating role of patient agility (PA). By integrating the dynamic capabilities perspective, the resource-based view, and socio-technical systems theory, the study seeks to explain how leadership is associated with coordination outcomes in complex healthcare environments. PATIENTS AND METHODS: Data were collected from a cross-national sample of 1,208 primary care managers in Sweden, Italy, Spain, and Germany using a structured self- reported online survey. The constructs were measured using validated multi-item scales and analyzed using structural equation modeling (SEM) in IBM SPSS AMOS. Reliability and validity were assessed through Cronbach's alpha, composite reliability (CR), average variance extracted (AVE), and the heterotrait-monotrait ratio (HTMT). RESULTS: The findings indicate that DTL is positive associated with patient agility (β = 0.733, p < 0.001), which in turn is positively associated with coordinated care (β = 0.761, p < 0.001). While the direct effect of DTL on coordinated care is statistically significant but weaker (β = 0.163, p < 0.01), patient agility partially mediates this relationship (β = 0.558, p < 0.001). The model demonstrates substantial explanatory power, accounting for 78.7% of the variance in coordinated care. CONCLUSION: The results suggest that digital transformational leadership is associated with coordinated care primarily through the development of patient agility as a dynamic organizational capability. The study highlights the importance of moving beyond technology adoption toward capability development in digital transformation initiatives. By identifying patient agility as a key mediating mechanism, the study offers theoretical and practical insights into how leadership can enhance coordination processes in primary healthcare.