Mental Toughness as a Predictor of Employee Engagement in Healthcare Leadership: Preliminary Findings From a Multi-Session Intervention

Engagement is a critical factor in both the performance and well-being of healthcare workforce, yet strategies to sustain it remain underdeveloped. Drawing from organizational psychology, a top-down approach can accelerate cultural and behavioral change across systems. Mental toughness (MT), a performance psychology construct associated with a mindset of purposefulness, efficiency, and flexibility, may serve as an actionable tool for leaders to enhance engagement within high-pressure environments, such as healthcare. PURPOSE: To examine the relationship between MT and engagement among senior hospital staff participating in a multi-session MT workshop – the focus is on whether MT predicts engagement and influences specific engagement subdomains over time. METHODS: A purposive sample of senior healthcare administrators (N = 14) participated in a four-session MT intervention over two months. So far, engagement (overall [OE] and subscales: Cognitive [CE], Emotional [EE], Behavioral [BE]) and MT were assessed at four time points using the Employee Engagement Scale and the Mental Toughness Index. Descriptive statistics, linear regression models, and change score analyses were used to examine the predictive relationships between MT and engagement via MATLAB. RESULTS: Regression analyses indicated MT significantly predicted OE at the second time point, R² = .95, p = .027. Associations at subsequent time points were weaker or nonsignificant, likely due to participant attrition. A change score analysis revealed a strong positive correlation between increases in MT and improvements in CE, r = .99, p = .006. No significant changes were found for EE or BE subdomains. CONCLUSION: This is the first study to examine the relationship between MT and employee engagement in a healthcare context. These preliminary findings suggest MT may serve as a leading indicator of engagement among healthcare professionals. The strongest impact was observed on CE, highlighting MT’s potential to enhance focus and attention at work. Future research with larger samples is warranted to confirm these results and support the development of targeted MT-based engagement interventions in healthcare settings.