{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T06:04:33Z","timestamp":1790661873571,"version":"4.1.0"},"reference-count":51,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"\n Aim<\/jats:title>\n This study examines how three types of leadership attention (noticing, interpreting, acting) are associated with online-offline healthcare service synergy (process and organizational synergy), along with motivational antecedents (credit claiming, blame avoidance) and contextual boundary conditions, using the APCC framework in the Chinese context.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n An exploratory sequential design was adopted. During the qualitative phase, data were triangulated from 41 interviews (hospital administrators, health bureau officials, clinicians), \u201cInternet\u202f+\u202fHealthcare\u201d policy documents, and literature review; items were generated via thematic analysis and expert panel validation. For the quantitative phase, quota sampling following regional distribution of China\u2019s internet healthcare users, yielding 450 valid responses from experienced professionals; data were analyzed with SPSS\/AMOS (SEM) and PROCESS macro for moderation.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The three attention types showed differentiated patterns. Acting had the strongest positive associations with process synergy (\n \u03b2<\/jats:italic>\n \u202f=\u202f0.53,\n p<\/jats:italic>\n \u202f&lt;\u202f0.001) and organizational synergy (\n \u03b2<\/jats:italic>\n \u202f=\u202f0.50,\n p<\/jats:italic>\n \u202f&lt;\u202f0.001). Noticing was positively associated with both (\n \u03b2<\/jats:italic>\n \u202f=\u202f0.26 and\n \u03b2<\/jats:italic>\n \u202f=\u202f0.29,\n p<\/jats:italic>\n \u202f&lt;\u202f0.001). Interpreting was only significantly associated with process synergy (\n \u03b2<\/jats:italic>\n \u202f=\u202f0.15,\n p<\/jats:italic>\n \u202f&lt;\u202f0.05), not organizational synergy. Credit claiming positively predicted all three attention types (\n \u03b2<\/jats:italic>\n \u202f=\u202f0.78\u20130.87,\n p<\/jats:italic>\n \u202f&lt;\u202f0.001); blame avoidance negatively predicted them (\n \u03b2<\/jats:italic>\n \u202f=\u202f\u22120.46 to \u22120.39,\n p<\/jats:italic>\n \u202f&lt;\u202f0.001). Contextual factors positively moderated the attention\u2013organizational synergy link (\n \u03b2<\/jats:italic>\n \u202f=\u202f0.113,\n p<\/jats:italic>\n \u202f&lt;\u202f0.01, 95%CI [0.02, 0.14]), with no moderation for process synergy.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n This study validates the APCC framework for digital healthcare integration, supporting the cognitive-behavioral logic of leadership attention from noticing through interpreting to acting. The findings indicate that only action-oriented attention is associated with addressing structural barriers and achieving organizational synergy, while interpretive attention is only associated with improved technical process integration. The study extends the Attention-Based View to healthcare and provides actionable strategies for advancing online-offline synergy.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1956639","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T05:47:41Z","timestamp":1790660861000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["How leadership attention is associated with online\u2013offline healthcare service synergy: differentiated effects of noticing, interpreting, and acting"],"prefix":"10.3389","volume":"14","author":[{"given":"Zhangzhang","family":"Zhao","sequence":"first","affiliation":[{"name":"School of Medical Humanities and Management, Wenzhou Medical University","place":["Wenzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wanyu","family":"Xu","sequence":"additional","affiliation":[{"name":"School of Medical Humanities and Management, Wenzhou Medical University","place":["Wenzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yitian","family":"Sun","sequence":"additional","affiliation":[{"name":"School of Medical Humanities and Management, Wenzhou Medical University","place":["Wenzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zehong","family":"Zhang","sequence":"additional","affiliation":[{"name":"School of Medical Humanities and Management, Wenzhou Medical University","place":["Wenzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1007\/bf00331431","article-title":"Basic concepts of synergetics","volume":"57","author":"Haken","year":"1993","journal-title":"Appl Phys A Mater Sci Process"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1002\/(SICI)1097-0266(199707)18:1+<187::AID-SMJ936>3.0.CO;2-K","article-title":"Towards an attention-based view of the firm","volume":"18","author":"Ocasio","year":"1997","journal-title":"Strateg Manag J"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"2450044","DOI":"10.1142\/s0219877024500445","article-title":"Does digital leadership impact the performance of lower-middle-class hospitals?","volume":"21","author":"Binsar","year":"2024","journal-title":"Int J Innov Technol Manag"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"382","DOI":"10.1108\/lhs-09-2024-0113","article-title":"Perceptions of digital transformation in lower-mid-level hospitals: analyzing leadership perspectives on digital adoption and patient-centered care","volume":"38","author":"Binsar","year":"2025","journal-title":"Leadersh Health Serv"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"391","DOI":"10.25300\/misq\/2022\/17248","article-title":"Understanding the digital resilience of physicians during the COVID-19 pandemic: an empirical study","volume":"47","author":"Liu","year":"2023","journal-title":"MIS Q"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1121290","DOI":"10.3389\/fpubh.2023.1121290","article-title":"Switching from offline to online health consultation in the post-pandemic era: the role of perceived pandemic risk","volume":"11","author":"Pan","year":"2023","journal-title":"Front Public Health"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1080\/07421222.2025.2602395","article-title":"Do mildly ill patients really need an offline doctor? 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