Core Competencies, Challenges, and Predictive Factors in Health Service Management: A Study of Transferred Sub-District Health Promoting Hospitals in Phitsanulok

The transfer of Subdistrict Health Promoting Hospitals to the Provincial Administrative Organization aims to improve primary care but faces management and workforce challenges, particularly in core competencies. This study assessed core competencies among staff of SHPHs transferred to the Phitsanulok PAO, identified related factors and challenges, and proposed policy recommendations. A mixed-method approach was conducted across 47 decentralized SHPHs, including qualitative interviews with 16 executives and staff and a quantitative survey (n = 141). Results showed high competency levels across all eight domains, with mean scores (M) ranging from 3.82 to 4.06 and standard deviations (SD) ranging from 0.609 to 0.764 on a 5-point scale. Personal factors, including job position, age, and work experience, were significantly associated with specific domains. Organizational factors, such as workforce development support, participation support, internal communication, resource management, and PAO support, were positively and significantly correlated with all domains. Predictive analysis indicated that these factors (β = 0.034–0.123) significantly enhanced competencies, with participation support identified as the most significant predictor, followed by internal communication. This suggests that policy-makers should prioritize inclusive governance and effective communication to enhance workforce readiness. Qualitative findings highlighted challenges of limited access, staff shortages, and outdated systems, whereas enablers included community engagement, leadership, integrated data, and professional development. While high competencies reflect strong workforce resilience, overcoming the resilience–infrastructure paradox through systemic and technological upgrades is essential for sustainable decentralized health management.