Dynamic managerial capabilities: the role of TMT cohesion in the relationship between transformational leadership and TMT efficacy in hospital context.

PURPOSE: The purpose of this study is to examine, in healthcare institutions, the mediating role of top management team (TMT) cohesion in the relationship between the CEO's transformational leadership (TL) and the efficacy of the TMT, positioning these three elements as dynamic managerial capabilities (DMC) that enable the organisation to better align with its environment.

DESIGN/METHODOLOGY/APPROACH: A structural equation model is used based on a survey conducted in public hospitals in the Valencian Community (Spain), with a total of 87 executives from 19 participating hospitals, covering almost all hospitals in the Valencian Community (20 hospitals).

FINDINGS: The results indicate that TMT cohesion plays an important mediating role in the relationship between TL and TMT efficacy.

PRACTICAL IMPLICATIONS: The findings suggest that CEO TL is associated with greater TMT cohesion, which is in turn associated with higher team efficacy. In healthcare organisations, where decision-making involves high professional diversity and uncertainty, cultivating a cohesive leadership climate supports more integrated decision-making and improves management effectiveness and organisational adaptability.

ORIGINALITY/VALUE: This study contributes to healthcare leadership research by examining how CEO TL, TMT cohesion and TMT efficacy are interrelated within the public hospital context, and by explaining why CEOs' TL does not always translate directly into higher TMT efficacy. The findings indicate that TMT cohesion plays a mediating role in this relationship. It further conceptualises these constructs as interrelated DMC with distinct but complementary adaptive functions, offering a novel perspective on how their interaction may support organisational adaptability and alignment with environmental demands.