The Kingdom of Saudi Arabia (KSA) and the Kingdom of Bahrain (KB) are currently in the process of the rapid transformation of health care to a self-sustained autonomous system. Middle managers play a pivotal role in achieving this goal. The aim of this study is to develop a feasible, reliable, and valid scale for measuring the leadership and managerial competencies of MM in KSA and KB. Zhou’s (2019) conceptual framework using a mixed-method approach was followed. After procuring ethical clearance from concerned authorities and informed consent from all the participants (n = 27), semi-structured interviews were conducted across three groups: Top Management (TM), Middle Management comprising of Middle Managers (MM), and Lower Management (LM) for the creation of items for the scale, which were later approved by five experts. Two hundred two participants from medical education (ME) and health care (HC) responded to the new scale. Cronbach\u27s alpha and exploratory and confirmatory factor analysis were performed to confirm internal consistency and validity. The model fit was adequate with a good GFI (0.90), TLI (0.96), and RMSEA (0.06). Seven major themes emerged from the thematic analysis, while a structural model with three inter-related constructs—“professionalism and problem solving,” “team management and adaptation,” and “time management and expertise” were recognized based on factor analysis. Both TM and LM identified the ability to motivate (70.8%) as comprising one of the most significant characteristics of MM. TM also indicated that concern and consideration of subordinates (68.8%) were important. LM considered being active (71.6%) as important for MM. Interestingly, MM had scored these attributes lower, illustrating the different ways in which MM is perceived across the three levels of management. Importantly, MM acknowledged concern for employee well-being, relationship, communication, and being active as crucial competencies, representing a mix of all competencies identified by the three levels of management. The “Leadership and Managerial Competency Scale for Middle Managers in Gulf Region (LMCS-MM Gulf Region)” developed under this study reflects what people in the three levels of management (lower, middle, and top) across ME and HC value in a (hypothetical) middle manager. This scale has several implications for the selection, training, and appraisal of MM in ME and HC. This dissertation is available in open access at AURA (https://aura.antioch.edu) and OhioLINK ETD Center (https://etd.ohiolink.edu)
