Financial Literacy and Leadership Skills Among Healthcare Professionals in Greece

Abstract

Healthcare professionals require comparable knowledge and abilities in hospital financial administration. In addition, many physicians are not equipped to manage the leadership roles that healthcare systems require, namely the capacity to express a vision, convey it to others, garner willing support for it, and enable others to be leaders in return. Previous studies have demonstrated that physicians often lack financial literacy, while a recent systematic review and meta-analysis showed that healthcare professionals lack adequate financial literacy, although top healthcare practitioners and executive nurse leaders are encouraged to develop knowledge and abilities outside of their clinical specialty. The need for medical practitioners to receive training and experience in medical leadership has also been discussed in earlier studies. In Greece, evidence regarding the financial literacy levels and leadership skills among healthcare professionals is lacking, although physicians and nurses are required to obtain managerial and administrative roles as they progress in their positions. Our objective was to assess healthcare professionals’ levels of financial literacy and investigate the relationship between financial literacy and leadership skills in Greece. We conducted a prospective, multi-centered, question-based survey among healthcare professionals in several institutions in Northern Greece. Participants were asked to fill out basic demographic questions, the OECD/INFE Toolkit for Measuring Financial Literacy and Financial Inclusion 2022, and the Leadership Skills questionnaire, translated into Greek. The factorability of the questionnaires was examined with factor analysis, while the internal consistency was examined with Cronbach’s alpha. A linear correlation of leadership scores with financial literacy scores was performed with the Spearman rho, and multivariate regression analysis examined the correlation of the leadership score with financial literacy scores, adjusted for the type of task, education, status, gender, and age. The overall financial literacy score for all healthcare professionals was 69.14 ± 13.25%, which was higher compared to the average for the Greek population. Male healthcare professionals with administrative tasks had significantly higher overall financial literacy and digital financial literacy scores than females, or professionals without administrative tasks, as well as higher scores in all areas of leadership. Physicians had significantly higher overall financial literacy scores than nurses and significantly lower digital financial behavior and digital finance trend scores. Still, physicians scored significantly lower than nurses in all areas of leadership skills. There was a strong correlation between overall financial and digital financial literacy scores with leadership skills scores. Future research is warranted to explore how formal financial and leadership education included in the training programs of healthcare professionals would empower physicians by enabling them to make proactive decisions regarding their financial and managerial destiny.

1. Introduction

The significance of financial literacy among healthcare professionals has been highlighted by recent developments in the contemporary role of nursing and medical leaders. Healthcare professionals should obtain managerial and leadership skills that are crucial to providing high-quality, cost-effective treatment (Blumenthal et al., 2012). Healthcare quality, financial planning, and patient safety are influenced by the healthcare professional’s capacity to decide which care services to provide and also supervise their delivery (Blumenthal et al., 2012). Healthcare professionals require comparable knowledge and abilities in hospital financial administration, and as specialists eventually advance into managerial roles, it becomes crucial to incorporate financial expertise in the healthcare sector. Furthermore, effective leaders in a variety of contexts exhibit the capacity to express a vision or objective, convey it to others, garner willing support for it, and enable others to be leaders in return through passion and collaboration (Antonakis, 2018). Research has shown that physician and nurse leaders positively affect patient outcomes in a range of clinical settings (Baggs et al., 1999; Corrigan et al., 2000; Kim et al., 2010; Neily et al., 2010). Moreover, evidence indicates that enhancing the leadership abilities of physicians improves patient outcomes (Ham, 2003; Majmudar et al., 2010; Squires et al., 2010). It has also been demonstrated that efforts to reform healthcare delivery systems and implement quality improvement initiatives are made easier by effective clinical leadership (Carroll, 2002; Nembhard & Edmondson, 2006; Porter & Teisberg, 2007).

Currently, the level of financial literacy among healthcare providers at various career stages has been investigated. Previous studies have demonstrated that physicians, despite having an advanced level of education, often lack financial literacy (Aery et al., 2017; Bhatacharya et al., 2023; Igu et al., 2022; Kovar et al., 2021; Royce et al., 2019; S. Sharma et al., 2021; Vengaloor Thomas et al., 2021). Many residents and medical students lack financial literacy, according to research (Ahmad et al., 2017; Bar-Or, 2015; Royce et al., 2019; Teichman et al., 2001), while even highly qualified medical staff at renowned hospitals lack basic financial knowledge. According to U.S. research, physicians’ credit scores were low, and they did not understand financial concepts (Ahmad et al., 2017). Additionally, a previous study revealed that about 80% of emergency care residents lacked financial planning training (Glaspy, 2005). Moreover, Lusco et al. found that 92% of surgical program directors believed that residents lacked the abilities needed to run their practices (Lusco et al., 2005). Studies on financial education have also brought attention to the instructional gap, showing that healthcare professionals’ training programs typically do not contain formal financial education (Aery et al., 2017; Igu et al., 2022; Safarani et al., 2018; Vengaloor Thomas et al., 2021). Moreover, our recent systematic review and meta-analysis showed that medical students and healthcare professionals lack adequate financial literacy, although top healthcare practitioners and executive nurse leaders are encouraged to develop knowledge and abilities outside of their clinical specialty (Pakos & Mpogiatzidis, 2025). Evidence also indicates that leadership skills are sometimes limited among healthcare professionals. Moreover, the majority of doctors are not equipped to handle the leadership responsibilities that healthcare systems require them to fulfil (Collins-Nakai, 2009; Hopkins et al., 2015). The necessity of medical leadership education and experience for medical students and doctors has also been previously documented (Berghout et al., 2017; Blumenthal et al., 2012; Dawson et al., 2005). Physicians in leadership positions today contend that a lack of education and experience makes them feel insecure, stressed, and frustrated and prevents them from carrying out their duties well (Berghout et al., 2017; Kippist et al., 2009). Medical students also support the addition of leadership and management training in medical curricula since they believe that their current program does not adequately prepare them for their future professions in medicine (Blumenthal et al., 2012; Saravo et al., 2017).

In Greece, a recent report by the General Secretariat of Financial Sector and Private Debt Management in the Hellenic Ministry of Economy and Finance that examined the financial literacy among adults and young people showed that adults scored on average 61% in financial literacy, namely 65% in financial knowledge, 62% in behavior, and 54% in financial attitudes (OECD, 2024a). Financial literacy was below average among women, the elderly, and individuals with less education and income. The average score for Greek individuals in digital financial literacy was 54% (OECD, 2024a). However, evidence regarding the financial literacy levels and leadership skills among healthcare professionals is lacking. Furthermore, the potential association between leadership skills and the level of financial literacy in healthcare professionals has not been examined. Given that in Greece, healthcare professionals, including physicians and nurses, are required to obtain managerial and administrative roles as they progress in their positions, we hypothesized that there would be a relationship between financial literacy and leadership skills.

Based on the above concept, our objective was to assess the levels of financial literacy and leadership skills in healthcare professionals in Greece, and secondly to examine the relationship between financial literacy and leadership skills.

2. Materials and Methods

2.1. Population

We conducted a prospective, multi-centered, question-based survey among healthcare professionals in several institutions in northern Greece. The participating institutions were the general hospitals of Veroia, Florina, Naousa, Giannitsa, Kozani, Ptolemaida, Kastoria, Grevena, Katerini, Edessa, and the general hospitals of Thessaloniki G.Gennimats-Agios Dimitrios, Papanikolaou, and Papageorgiou. Subjects were approached in person by the principal investigator and were asked to participate in the survey by filling out basic demographic questions, a questionnaire about financial literacy, and a questionnaire about leadership skills. The survey was carried out from December 2024 to January 2025. Participants were asked to complete data regarding their age, gender, primary and secondary degree, working hospital, working position, and years of working experience.

2.2. Instrument

2.2.1. Assessment of Financial Leadership

In this study, the OECD/INFE 2022 Toolkit for Measuring Financial Literacy and Financial Inclusion, translated into Greek, served as the basis for the survey that was used to gather information on Greek healthcare professionals (OECD, 2022). Before research started, the translated and updated versions were tested on a small group of participants to ensure that the alternatives were obvious, and the translation was easy to comprehend.

To measure levels of financial literacy, financial inclusion, financial resilience, and financial well-being, the OECD/INFE Toolkit for Measuring Financial Literacy and Financial Inclusion 2022 included 28 items that were intended to gather data on financial behavior, attitudes, and knowledge as well as several financial outcomes. In the financial literacy score, nine items were designed to estimate financial behavior, two items financial attitudes, and seven items financial knowledge. In digital financial literacy, four items were designed to estimate digital financial behavior, three items digital financial attitudes, and three items digital financial knowledge.

• Convergent and discriminant validity and reliability

Exploratory factor analysis was used to assess the questionnaire’s convergent and discriminant validity. Initially, the factorability of the 28 OECD/INFE Toolkit for Measuring Financial Literacy and Financial Inclusion 2022 items was examined. First, a decent factorability was suggested by the observation that 25 out of the 28 items had a correlation of at least 0.3 with at least one other item (Supplemental Table S1). Second, Bartlett’s test of sphericity was significant (x² = 1572.34, p < 0.001), and the Kaiser–Meyer–Olkin measure of sample adequacy was 0.63, above the generally advised value of 0.6 (Supplemental Table S2). Lastly, all the communalities were above 0.3, which further supported the idea that every item shared some variance with every other item. Taking these broad indicators into account, factor analysis was deemed suitable for all 28 items. Twelve factors were found to account for 72% of the variance in the principal component factor analysis employing oblimin rotation (Supplemental Table S3).

The reliability of the OECD/INFE Toolkit for Measuring Financial Literacy and Financial Inclusion was examined using Cronbach’s alpha. The alpha was moderate: 0.68. Eliminating additional items would not have resulted in any notable improvements in the alpha.

• Estimation of financial literacy score

The sum of the three scores was used to determine the overall financial literacy score—financial behavior (9), financial attitudes (4), and financial knowledge (7), taking any value between 0 and 20—and it was normalized to 100 for reporting by multiplying by 100/20. The total digital financial literacy score was taken as the sum of the three components—behavior (4), attitudes (3), and knowledge (3), taking any value between 0 and 10—and it was normalized to 100 for reporting by multiplying by 100/10.

2.2.2. Assessment of Leadership Skills

The assessment of participants’ leadership skills was carried out using the Leadership Skills Questionnaire [Introduction to Leadership, Peter G. Northouse, Second Edition (https://us.sagepub.com/sites/default/files/upm-binaries/40151_Chapter1.pdf, accessed on 4 April 2024)].

Three main categories of leadership abilities—managerial, interpersonal, and conceptual—were intended to be assessed by the Leadership Skills Questionnaire. The areas of leadership strengths and weaknesses can be identified by comparing scores. The Leadership Skills Questionnaire’s objective is to assess leadership abilities and document their profile by highlighting their advantages and disadvantages.

• Convergent and discriminant validity and reliability

Exploratory factor analysis was used to assess the questionnaire’s convergent and discriminant validity. When the 18-item Leadership Skills Questionnaire’s factorability was analyzed, it was found that 17 of the 18 items had a correlation of at least 0.3 with at least one other item, indicating that the factorability was reasonable (Supplemental Table S4). Second, Bartlett’s test of sphericity was significant (x² = 1849.61, p < 0.001), and the Kaiser–Meyer–Olkin measure of sample adequacy was 0.74, higher than the generally advised norm of 0.6 (Supplemental Table S5). Lastly, all the communalities were above 0.3, which further supported the idea that every item shared some variance with every other item. Taking these broad indicators into account, factor analysis was deemed suitable for all 18 items. Five factors were found to account for 61% of the variance in the principal component factor analysis employing oblimin rotation (Supplemental Table S6).

The reliability of the Leadership Skills Questionnaire was examined using Cronbach’s alpha. The alpha was 0.82. Eliminating additional items would not have resulted in any notable improvements in alpha.

• Estimation of leadership skills score

To complete the questionnaire, the answers were scored by summing up the answers about management skills score, interpersonal skills score, and conceptual skills score. Based on the following scale, the scores were interpreted as follows: 26–30 represented the very high range, 21–25 the high range, 16–20 the moderate range, 11–15 the low range, and 6–10 the very low range.

2.3. Statistical Analysis

The sample characteristics were calculated and expressed according to the principles of descriptive statistics. The quantitative-continuous variables were expressed as mean value ± standard deviation (SD) or median (interquartile range) (IQR), depending on whether the variance of their values followed the principles of normal distribution. The normality of the distribution of continuous quantitative variables was determined with the Kolmogorov–Smirnov test or the Shapiro–Wilk test, as appropriate. Qualitative categorical variables were expressed as frequency in terms of absolute value (n) and percentage (%).

An analysis was carried out on the demographic characteristics of the sample, the calculation of financial literacy, and the leadership skills of the participants, with a subgroup analysis between professionals with administrative duties versus professionals without administrative duties, university education professionals versus technical education professionals, medical versus nursing staff, and men versus women. The comparison of quantitative continuous variables between the subgroups of the study was performed with the student’s unpaired t-test or the non-parametric Mann–Whitney test. The comparison of qualitative categorical variables was performed with the Pearson chi-square test (x²) after Yates’ continuity-corrected chi-square test, or in case the number of expected observations was less than 5 in more than 20% of the cells of the affinity tables, Fisher’s exact test was used.

A linear correlation of leadership scores with financial literacy scores was performed with the Spearman rho correlation analysis. Finally, using the multivariate regression analysis, we examined the correlation of the leadership score with financial literacy scores, adjusted for the following confounding factors: type of task (administrative versus non-administrative tasks), type of education (university versus technical education), status (medical versus nursing staff), gender (male versus female), and age. For each parameter, the beta factor (b) and confidence interval (CI) were calculated at 95%. All tests were two-sided, and the acceptable level of statistical significance was set at 5% (p < 0.05). The data were analyzed using the statistical program Microsoft Excel 365 (Microsoft, Redmond, WA, USA), and SPSS 24.0 (IBM SPSS Statistics for Windows, Version 24.0. Armonk, NY, USA: IBM Corp.).

2.4. Sample Calculation and Study Power

The power analysis revealed that based on the reported financial literacy score of 61% for Greece (OECD, 2024a), a sample of more than 282 participants was sufficient to detect the desired absolute difference of 5% in financial literacy scores, or leadership skills, between any two groups, with a strength of 80% and a type I error of <0.05.

3. Results

3.1. Demographic Characteristics

The current study included 300 healthcare professionals, with 120 (40%) men and 180 (60%) women. The median age of participants was 48 (27–59) years. Of the 300 participants, 205 (69%) had received a basic university education, and 95 (31%) technical education. Also, 150 (50%) held a master’s degree and 77 (26%) held a doctoral degree. In total, 171 (57%) subjects were doctors and 129 (43%) nurses, while 162 (54%) professionals reported that they performed administrative duties and 138 (46%) that they did not.

3.2. Financial Literacy

The overall financial literacy score for all healthcare professionals was 13.83 ± 2.65 or 69.14 ± 13.25% (adjusted score). More specifically, the financial behavior score was 6.4 ± 1.72, the financial attitudes score was 2.32 ± 1.07, and the financial knowledge score was 5.11 ± 1.47. The digital financial literacy score was 5.4 ± 1.7 or 53.97 ± 17.07% (adjusted score) and specifically, the digital financial behavior score was 2.69 ± 0.84, the digital financial attitudes score was 1.27 ± 0.66, and the digital financial knowledge score was 1.43 ± 0.96, as depicted in

Table 1. Financial literacy score, digital financial literacy score, and leadership skills score of all respondents and between subgroups of participants.

Financial Literacy Score	Overall	Administrative Tasks	Non-Administrative Tasks	p-Value	University Education	Technical Training	p-Value	Medical Staff	Nursing Staff	p-Value	Men	Women	p-Value
Total	13.83 ± 2.65	14.14 ± 2.48	13.47 ± 2.80	0.029 *	14.23 ± 2.69	12.97 ± 2.33	<0.001 *	14.37 ± 2.67	13.10 ± 2.44	<0.001 *	15.20 ± 2.60	12.91 ± 2.26	<0.001 *
Behavior	6.4 ± 1.72	6.39 ± 1.58	6.41 ± 1.89	0.933 *	6.69 ± 1.75	5.77 ± 1.50	<0.001 *	6.79 ± 1.79	5.88 ± 1.48	<0.001 *	7.06 ± 1.60	5.96 ± 1.67	<0.001 *
Attitudes	2.32 ± 1.07	2.34 ± 1.12	2.29 ± 1.00	0.711 *	2.33 ± 1.02	2.28 ± 1.16	0.708 *	2.42 ± 0.88	2.18 ± 1.26	0.068 *	2.40 ± 0.97	2.26 ± 1.13	0.243 *
Knowledge	5.11 ± 1.47	5.41 ± 1.24	4.77 ± 1.63	<0.001 *	5.20 ± 1.58	4.92 ± 1.15	0.113 *	5.16 ± 1.52	5.05 ± 1.39	0.495 *	5.74 ± 1.30	4.69 ± 1.42	<0.001 *
Adjusted overall score (%)	69.14 ± 13.25	70.68 ± 12.40	67.34 ± 14.01	0.029 *	71.13 ± 13.49	64.84 ± 11.66	<0.001 *	71.87 ± 13.39	65.52 ± 12.19	<0.001 *	76.02 ± 13.01	64.56 ± 11.30	<0.001 *
Digital Financial Literacy Score
Total	5.4 ± 1.7	5.72 ± 1.67	5.02 ± 1.67	<0.001 *	5.24 ± 1.70	5.73 ± 1.67	0.023 *	5.27 ± 1.69	5.56 ± 1.71	0.155 *	5.84 ± 1.48	5.10 ± 1.78	<0.001 *
Behavior	2.69 ± 0.84	2.75 ± 0.84	2.62 ± 0.84	0.185 *	2.61 ± 0.78	2.87 ± 0.93	0.012 *	2.61 ± 0.80	2.81 ± 0.88	0.044 *	2.74 ± 0.70	2.66 ± 0.92	0.394 *
Attitudes	1.27 ± 0.66	1.42 ± 0.64	1.09 ± 0.63	<0.001 *	1.15 ± 0.66	1.54 ± 0.58	<0.001 *	1.18 ± 0.67	1.39 ± 0.62	0.007 *	1.34 ± 0.60	1.22 ± 0.69	0.126 *
Knowledge	1.43 ± 0.96	1.54 ± 0.92	1.30 ± 0.99	0.032 *	1.49 ± 1.02	1.32 ± 0.80	0.149 *	1.49 ± 1.01	1.36 ± 0.88	0.271 *	1.76 ± 0.97	1.22 ± 0.88	<0.001 *
Adjusted overall score (%)	53.97 ± 17.07	57.16 ± 16.77	50.22 ± 16.71	<0.001 *	52.44 ± 17.06	57.26 ± 16.72	0.023 *	52.75 ± 16.94	55.58 ± 17.18	0.155 *	58.42 ± 14.89	51.00 ± 17.81	<0.001 *
Leadership skills score
Management skills	22.89 ± 2.84	23.67 ± 2.21	21.98 ± 3.21	<0.001 *	23.22 ± 2.65	22.74 ± 2.97	0.171 *	22.56 ± 2.96	23.33 ± 2.62	0.017 *	23.81 ± 2.36	22.28 ± 2.98	<0.001 *
Scale				<0.001 #			0.002 #			0.009 #			0.001 #
Very high	60 (20%)	34 (21%)	26 (19%)		40 (19%)	20 (21%)		34 (20%)	26 (20%)		32 (27%)	28 (15%)
High	179 (59.5%)	120 (74%)	59 (43%)		111 (54%)	68 (72%)		91 (53%)	88 (68%)		77 (64%)	102 (57%)
Moderate	60 (20%)	8 (5%)	52 (37%)		53 (26%)	7 (7%)		45 (26%)	15 (12%)		11 (9%)	49 (27%)
Low	1 (0.5%)	-	1 (1%)		1 (1%)	-		1 (1%)	-		-	1 (1%)
Very low	-	-	-		-	-		-	-		-	-
Interpersonal skills	19.6 ± 2.13	20.15 ± 1.83	18.96 ± 2.26	<0.001 *	19.40 ± 2.27	20.02 ± 1.72	0.010 *	19.27 ± 2.29	20.04 ± 1.81	0.001 *	19.93 ± 2.01	19.38 ± 2.18	0.027 *
Scale				0.022 #			0.069 #			0.063 #			0.003 #
Very high	-	-	-		-	-		-	-		-	-
High	103 (34%)	66 (41%)	37 (27%)		75 (37%)	28 (30%)		59 (35%)	44 (34%)		55 (46%)	48 (27%)
Moderate	190 (64%)	94 (58%)	96 (70%)		123 (60%)	67 (70%)		105 (61%)	85 (66%)		63 (52%)	127 (71%)
Low	7 (2%)	2 (1%)	5 (3%)		7 (3%)	-		7 (4%)	-		2 (2%)	5 (3%)
Very low	-	-	-		-	-		-	-		-	-
Conceptual skills	23.17 ± 2.74	23.85 ± 2.26	22.38 ± 3.03	<0.001 *	22.88 ± 2.82	23.80 ± 2.46	0.007 *	22.84 ± 2.74	23.61 ± 2.69	0.016 *	23.63 ± 2.24	22.87 ± 2.99	0.012 *
Scale				<0.001 #			0.003 #			0.076 #			0.005 #
Very high	56 (19%)	34 (21%)	22 (16%)		34 (17%)	22 (23%)		28 (16%)	28 (22%)		24 (20%)	32 (18%)
High	193 (64%)	118 (73%)	75 (54%)		126 (61%)	67 (71%)		107 (63%)	86 (67%)		86 (72%)	107 (59%)
Moderate	51 (17%)	10 (6%)	41 (30%)		45 (22%)	6 (6%)		36 (21%)	15 (11%)		10 (8%)	41 (23%)
Low	-	-	-		-	-		-	-		-	-
Very low	-	-	-		-	-		-	-		-	-

Continuous variables are expressed as mean value ± standard deviation (SD). * p-value of the student’s unpaired t-test. Categorical variables are expressed as absolute value (n) and percentage (%). ^# p-value of the Pearson chi-square test (x²) or Fisher’s exact test.

.

In the subgroup analysis, we found that professionals with administrative tasks had a significantly higher overall financial literacy score of 14.14 ± 2.48 or 70.68 ± 12.40% (adjusted score), compared to non-administrative professionals of 13.47 ± 2.80 or 67.34 ± 14.01 (adjusted score) (p = 0.029). University education professionals had a significantly higher overall financial literacy score of 14.23 ± 2.69 or 71.13 ± 13.49% (adjusted score), versus technical education professionals of 12.97 ± 2.33 or 64.84 ± 11.66 (adjusted score) (p < 0.001). The digital financial literacy score was in contrast lower among university education professionals 5.24 ± 1.70 or 52.44 ± 17.06% (adjusted score) versus technical education professionals 5.73 ± 1.67 or 57.26 ± 16.72% (adjusted score) (p = 0.023) (Table 1). Moreover, physicians had a significantly higher overall financial literacy score of 14.37 ± 2.67 or 71.87 ± 13.39% (adjusted score), versus nurses 13.10 ± 2.44 or 65.52 ± 12.19 (adjusted score) (p < 0.001), whereas the overall digital financial literacy score did not differ between the two groups. Finally, it was observed that men had a significantly higher overall financial literacy score of 15.20 ± 2.60 or 76.02 ± 13.01% (adjusted score), compared to women of 12.91 ± 2.26 or 64.56 ± 11.30 (adjusted score) (p < 0.001). Men also had a significantly higher overall digital financial literacy score of 5.84 ± 1.48 or 58.42 ± 14.89% (adjusted score) versus 5.10 ± 1.78 or 51.00 ± 17.81% (adjusted score) of women, (p < 0.001) (Table 1).

3.3. Leadership Skills

In terms of leadership assessment, the score for managerial skills was 22.89 ± 2.84, interpersonal 19.6 ± 2.13 and conceptual 23.17 ± 2.74. 20% (60/300 respondents) of professionals were at a very high level, 59.5% (179/300 respondents) at a high level of managerial skills, 34% (103/300 respondents) at a high level of interpersonal skills, while 19% (56/300 respondents) were at a very high level and 64% (193/300 respondents) at a high level of conceptual skills (Table 1).

In subgroup analysis, professionals with managerial duties scored higher than professionals without managerial duties in all areas, as depicted in Table 1. University education professionals scored similarly to technical education professionals in the management skills area, but significantly lower in the interpersonal skills areas 19.40 ± 2.27 vs. 20.02 ± 1.72 (p = 0.010) and conceptual skills 22.88 ± 2.82 vs. 23.80 ± 2.46 (p = 0.007). Also, physicians scored significantly lower than nurses in administrative skills of 22.56 ± 2.96 vs. 23.33 ± 2.62 (p = 0.017), interpersonal skills of 19.27 ± 2.29 vs. 20.04 ± 1.81 (p = 0.001), and conceptual skills of 22.84 ± 2.74 vs. 23.61 ± 2.69 (p = 0.016). Finally, men scored significantly higher than women in all areas of leadership skills, namely management skills 23.81 ± 2.36 vs. 22.28 ± 2.98 (p < 0.001), interpersonal skills 19.93 ± 2.01 vs. 19.38 ± 2.18 (p = 0.027), and conceptual skills 23.63 ± 2.24 vs. 22.87 ± 2.99 (p = 0.012) (Table 1).

3.4. Association of Financial Literacy with Leadership Skills

In the linear correlation between leadership scores and financial literacy scores, there was a significant, although weak, correlation between all areas of leadership skills and overall financial literacy scores. Specifically, there was a weak correlation between the overall financial literacy score and management skills score (r = 0.28, p < 0.001), interpersonal skills (r = 0.12, p = 0.049), and conceptual skills (r = 0.22, p < 0.001) (

Table 2. Correlation of leadership skill scores with overall financial literacy scores and overall digital financial literacy scores.

	rho	p-Value *
Overall financial literacy score
Management skills score	0.28	<0.001
Interpersonal skills score	0.12	0.049
Conceptual skills score	0.22	<0.001
Overall Digital Financial Literacy Score
Management skills score	0.17	0.002
Interpersonal skills score	0.19	0.001
Conceptual skills score	0.17	0.003

* p-value of Spearman’s rho.

). Also, a significant weak correlation was observed between all areas of leadership skills and overall digital financial literacy score, namely, a correlation between overall digital financial literacy score and management skills score (r = 0.17, p = 0.002), interpersonal skills (r = 0.19, p = 0.001), and conceptual skills (r = 0.17, p = 0.003) (Table 2).

In the multivariate regression analysis of leadership scores with financial literacy scores, adjusted for task type (administrative versus non-administrative tasks), type of education (university education versus technical education), status (medical versus nursing staff), gender (men versus women), and age, overall financial literacy scores were found to be strongly positively associated with management skills score (b = 0.21, 95% CI 0.05, 0.37, p = 0.010), conceptual skills score (b = 0.19, 95% CI 0.03, 0.36, p = 0.020), university education (b = 1.95, 95% CI 1.15, 2.76, p < 0.001), and negatively with female sex (b = −0.93, 95% CI −1.54, −0.33, p = 0.002). Also, overall digital financial literacy scores were strongly positively associated with interpersonal skills score (b = 0.11, 95% CI 0.01, 0.21, p = 0.049), conceptual skills score (b = 0.11, 95% CI 0.04, 0.22, p = 0.042), and negatively with female gender (b = −0.49, 95% CI −0.90, −0.08, p = 0.018) (

Table 3. Multivariate linear regression analysis of financial literacy score and digital financial literacy score with leadership scores, adjusted for the type of tasks (administrative versus non-administrative tasks), type of education (university versus technical education), status (medical versus nursing staff), gender (male versus female), and age.

	b	p-Value	95% CI
Overall financial literacy score
Management skills score	0.21	0.010	0.05, 0.37
Interpersonal skills score	0.08	0.923	−0.14, 0.16
Conceptual skills score	0.19	0.020	0.03, 0.36
Administrative tasks	0.26	0.443	−0.41, 0.93
Level of education	1.95	<0.001	1.15, 2.76
Property	0.37	0.371	−0.44, 1.20
Gender	−0.93	0.002	−1.54, −0.33
Age	0.03	0.113	−0.07, 0.07
Overall Digital Financial Literacy Score
Management skills score	0.01	0.850	−0.10, 0.12
Interpersonal skills score	0.11	0.049	0.01, 0.21
Conceptual skills score	0.11	0.042	0.04, 0.22
Administrative tasks	−0.02	0.919	−0.48, 0.43
Level of education	0.14	0.600	−0.40, 0.69
Property	0.47	0.095	−0.08, 1.03
Gender	−0.49	0.018	−0.90, −0.8
Age	0.01	0.684	−0.02, 0.03

CI, confidence interval.

).

4. Discussion

In the current study, we found that the overall financial literacy score for all healthcare professionals was 13.83 ± 2.65 or 69.14 ± 13.25% (adjusted score), and the digital financial literacy score was 5.4 ± 1.7 or 53.97 ± 17.07% (adjusted score), which were higher compared to the average for the Greek population (OECD, 2024a). In terms of leadership assessment, the score for managerial skills was 22.89 ± 2.84, interpersonal skills 19.6 ± 2.13, and conceptual skills 23.17 ± 2.74. Healthcare professionals with administrative tasks had significantly higher overall financial literacy and digital financial literacy scores than professionals without administrative tasks, as well as higher scores in all areas of leadership. University education professionals had significantly higher overall financial literacy scores, but significantly lower digital financial literacy scores compared to technical education professionals. Also, university education professionals scored significantly lower in the areas of interpersonal and conceptual leadership skills than technical education professionals. Physicians had significantly higher overall financial literacy scores than nurses and significantly lower digital financial behavior and digital finance trend scores, although the overall digital financial literacy score did not differ between the two groups. Still, physicians scored significantly lower than nurses in all areas of leadership skills. Men had significantly higher overall financial literacy scores, higher overall digital financial literacy scores, and significantly higher scores across all areas of leadership skills than women. In our analysis, we found that there was a strong linear correlation between overall financial literacy score and digital financial literacy score with management, interpersonal, and conceptual skills scores. Finally, the overall financial literacy scores were positively related to management skills scores, conceptual skills scores, and university education, and negatively to the female gender, while overall digital financial literacy scores were positively related to interpersonal skills scores, conceptual skills scores, and negatively to the female gender.

The role of healthcare leaders has evolved considerably since their training many years ago, and although it is not currently required, physicians and nurses in leadership positions are expected to comprehend and oversee hospital finances (Waxman & Schaefer, 2010). Previous research has focused on healthcare professionals’ financial literacy because financial management has an impact on hospital management effectiveness (Khosravi et al., 2022; Sepehri, 2014; Sohrabi et al., 2021; Torkzad & Beheshtinia, 2019). Moreover, in the modern healthcare industry, physician competence is crucial to day-to-day management, delivering high-quality care, performing research, and creating innovative therapies, diagnostics, and health education programs. An appropriate education in hospital financial administration, encompassing financial planning, monitoring, and decision-making as well as fiscal control (Asamani et al., 2013; Naranjee et al., 2019; Thew, 2015) is crucial since nurses and nursing leaders may find it difficult to understand money and take charge of nursing departments’ financial operations (Douglas, 2010). Overall, our study suggests that male healthcare physicians with administrative tasks had advanced financial literacy and leadership skills, underscoring, however, that doctors compared with nurses lack digital financial literacy and leadership skills.

In Greece, financial literacy score is comparable to the OECD/INFE 2023 International Survey of Adult Financial Literacy average of 63% for the 19 EU member states that took part (OECD, 2023). Individuals need to acquire new digital and financial skills in order to take advantage of the growing digitization of the Greek retail financial market and safeguard themselves against the associated hazards (OECD, 2024b). The findings of the two surveys conducted among Greek adults and high school students offer compelling evidence of the need to raise financial literacy levels generally and among specific demographic groups, including women, young adults, and the elderly. Based on these findings, financial literacy policies should place a high priority on raising awareness and understanding of various financing options, understanding the features of various external finance products and how they operate, comprehending how banks, investors, and other external finance providers make decisions, assisting in the development of efficient risk management strategies, and educating the public about the advantages and operations of insurance products.

Our findings are in line with previous evidence that demonstrated that financial literacy varies among healthcare professionals, based on several factors. Financial literacy has been shown to be influenced by age and gender; higher financial literacy has been associated with male sex, marriage, age, education, medical specialization, and annual family income (Agarwal & Biswas, 2022; Millen & Stacey, 2022; Topa et al., 2018). In our study, the profile of a male healthcare professional with administrative tasks was associated with the highest overall and digital financial literacy scores. However, doctors and healthcare professionals with university education in general found it difficult to corporate with digital financial literacy. As previously noted, among all healthcare professions, doctors are the main human resource supporting the overall financial system (Bhatacharya et al., 2023). In addition to being ill-equipped, doctors find it challenging to make financial decisions and deal with financial issues during their professional careers (Ahmad et al., 2017; Boehnke et al., 2018; Jayakumar et al., 2017; Pisaniello et al., 2019; Satiani, 2004; A. N. Sharma & Rojek, 2019). However, among other high-level healthcare workers, top doctors and executive nurse executives need to be able to develop financial statistics and plans for their organizations. Additionally, studies of senior healthcare practitioners indicated that they were encouraged to expand their knowledge and skills beyond their clinical specialization, despite the fact that senior physicians or executive nurse leaders may have a moderate level of financial literacy. Prominent healthcare professionals may possess advanced financial literacy, depending on their age and amount of experience (Brydges et al., 2019; Topa et al., 2018), but this may not be sufficient to support their financial leadership role (Gačić et al., 2023). Our findings indicate that men physicians with administrative tasks have an advanced overall financial literacy; nonetheless, they face difficulties in adopting modern ways of digital financial behavior.

Our findings also revealed that male healthcare professionals with administrative tasks had high leadership skills scores, whereas physicians scored significantly lower than nurses in all areas of leadership skills. Despite the fact that research and practice both encourage and support the growth of medical leadership, there is still a lack of conceptual clarity regarding the relative importance of the elements associated with successful leadership (Berghout et al., 2017). Leadership duties are unfamiliar and surprising to many doctors, mostly due to the lack of emphasis placed on them during medical school and residency training. On the other hand, healthcare professionals and mainly nurses who have obtained practical experience for many years following university acquire these vital abilities through ad hoc leadership experiences or while managing care teams (Cooke et al., 2006; Kuo et al., 2010). This disparity has been exacerbated by the historical undervaluation of leadership development and recognition of successful leaders in residency programs (Cooke et al., 2006; Stoller, 2009). Few clinical training programs offer properly structured, evidence-based leadership and management training for all residents, even though many residency programs offer this skill to residents interested in executive leadership and hospital administration (Ackerly et al., 2011). On the other hand, previous studies show that good clinical nursing leadership lowers staff burnout rates, improves nursing job satisfaction and retention, and is linked to fewer patient falls and medication errors (Anderson et al., 2003; Cook & Leathard, 2004; Wong et al., 2013).

The findings of the current study suggested a weak association between overall financial and digital financial literacy with leadership skills. The overall financial and digital literacy scores were positively related to leadership skills scores after adjusting for other cofactors, indicating the importance of holding both financial literacy and leadership skills in the healthcare sector. In the contemporary practice setting, doctors’ leadership and management abilities are critical to the quality of healthcare and the effectiveness of the organization since they are no longer able to achieve the best possible patient results alone. Providing high-quality care necessitates that doctors manage huge, diverse teams, negotiate ever-more-complex human and technology systems, and concurrently monitor the care of numerous patients, each of whom has several care objectives (Blumenthal et al., 2012).

Based on our findings, it could be proposed that hospitals should shift their emphasis when choosing medical managers from doctors who are highly regarded by their peers or who are renowned for their medical prowess to doctors with optimal financial literacy who have excellent interpersonal skills in collaboration and communication, who have a clear vision, and who can effectively communicate it to others. Therefore, future medical leadership development programs, hospital training for medical managers and leaders, and medical curricula should place more emphasis on personal development, specifically communication and teamwork skills, having a clear vision and being able to communicate it to others, and conflict resolution. These are considered more significant than concentrating only on management and financial abilities or understanding of the healthcare system (Chen, 2018). Gaining the necessary knowledge for decision-making should preferably be done prior to the pressing necessity for such decisions, as financial education and leadership skills are not adequately incorporated into healthcare education. The best course of action would be to give pupils a thorough foundation in financial literacy that they may modify to fit their unique situation; this framework should contain a critical mass of fundamental information. The curriculum for medical school and graduate medical education should include workshops on the fundamentals of personal financial planning as well as significant financial and leadership issues related to medical practice.

The limitations of our study should be acknowledged. First, our study included mainly senior healthcare professionals and thus, the results should be cautiously interpreted regarding junior doctors and nurses. However, senior doctors and nurses are the healthcare providers who are expected to transact administrative tasks related to financial literacy and leadership skills. Also, our study was performed in several institutions around northern Greece and therefore, our results could not be generalized to the entire healthcare population.

5. Conclusions

Organizations are driven to improve health sector management in the modern period, and since hospital management efficacy is impacted by financial management, financial literacy among healthcare personnel has gained attention. For healthcare professionals who are the most qualified for managerial roles in the healthcare industry, financial literacy and leadership are therefore critical competencies.

In the current study, the overall financial and digital financial literacy score for all healthcare professionals was higher compared to the average for the Greek population. Male healthcare professionals with administrative tasks had significantly higher overall financial and digital financial literacy scores than females or professionals without administrative tasks, as well as higher scores in all areas of leadership. Physicians had significantly higher overall financial literacy scores than nurses, but significantly lower digital financial behavior and digital finance trend scores. Still, physicians scored significantly lower than nurses in all areas of leadership skills. There was a weak correlation between overall financial and digital financial literacy scores with leadership skills scores. Finally, the overall financial and digital literacy scores were positively related to leadership skills scores after adjusting for other cofactors.

Hospitals should prioritize choosing doctors with the best financial literacy, exceptional interpersonal skills for communication and teamwork, a clear vision, and the capacity to successfully communicate it to others when choosing medical administrators. Additionally, future medical leadership development programs, hospital training for medical managers and leaders, and medical curricula should place more emphasis on personal development, particularly communication and teamwork skills, having a clear vision and being able to communicate it to others, and conflict resolution. Future studies are necessary to examine how formal financial and leadership education, which should be a part of healthcare professionals’ training programs from undergraduate to graduate school and beyond, would empower doctors by giving them the ability to manage their finances and make proactive choices about their managerial and financial future.