Institutional context and health workforce intentions to adopt holistic care competencies: evidence from teaching hospitals in Taiwan

PURPOSE: Strengthening holistic care competencies among the healthcare workforce has become an important strategy for promoting people-centered health systems. Teaching hospitals play a central role in workforce training; however, differences in institutional context across hospital levels may influence workforce adoption. This study examines how institutional context shapes health workforce intention to adopt holistic care competencies in Taiwanese teaching hospitals. DESIGN/METHODOLOGY/APPROACH: A cross-sectional survey was conducted between July and December 2022 among clinical supervisors and postgraduate trainees from one medical center and one regional teaching hospital in Taiwan (n = 703). Drawing on the theory of planned behavior, the study measured attitudes, subjective norms, perceived behavioral control and behavioral intention toward adopting holistic care competencies. Independent-sample t-tests and multiple regression analyses were used to examine determinants of adoption intention. Structural differences between hospital levels were further tested using a Chow test. FINDINGS: Health workforce members in medical centers reported significantly stronger behavioral intention to adopt holistic care competencies than those in regional hospitals (mean = 3.88 vs. 3.78, p = 0.044). Among clinical supervisors, medical centers demonstrated significantly higher levels of attitudes, subjective norms, perceived behavioral control and behavioral intention. Across both hospital types, subjective norms and perceived behavioral control were the strongest predictors of adoption intention (medical centers: ß = 0.309 and 0.434; regional hospitals: ß = 0.240 and 0.561; p < 0.001). The models demonstrated substantial explanatory power (R2 = 0.556-0.637). Chow test results indicated significant structural differences between hospital levels (F = 19.85, p < 0.001), suggesting that institutional context shapes the determinants of workforce adoption. RESEARCH LIMITATIONS/IMPLICATIONS: This study has several limitations. First, the cross-sectional design limits causal inference. Second, the sample was drawn from two teaching hospitals in Taiwan, which may limit generalizability to other healthcare systems or institutional contexts. Future research could employ longitudinal designs and include a broader range of hospitals to further examine how institutional environments influence workforce adoption of holistic care competencies. PRACTICAL IMPLICATIONS: The findings highlight the importance of institutional support in promoting workforce adoption of holistic care competencies. Hospitals, particularly regional teaching hospitals, may strengthen adoption by providing structured training opportunities, mentorship programs and organizational recognition mechanisms. Aligning accreditation requirements with practical institutional support may also help translate policy expectations into sustainable workforce development practices. SOCIAL IMPLICATIONS: Promoting holistic care competencies among healthcare professionals may enhance patient-centered care by encouraging clinicians to consider patients' psychological, social and family contexts in addition to medical treatment. Strengthening workforce capacity in holistic care may therefore contribute to more responsive healthcare systems and improved patient experiences. ORIGINALITY/VALUE: This study contributes to health organization and workforce research by demonstrating how institutional context may influence the behavioral mechanisms underlying workforce adoption of holistic care competencies. The findings highlight the importance of institutional support and perceived behavioral control in shaping workforce adoption and suggest that targeted workforce development strategies are particularly needed in resource-constrained regional hospitals.