Digital Leadership Enhances Employee Empowerment,Techno-work Engagement,and Sustainability: SEM Analysis in Public Healthcare

Abstract

The rapid digital transformation in the public healthcare sector demands effective digital leadership to improve organizational performance. This study investigates the impact of digital leadership on employee empowerment and its subsequent effects on techno-work engagement and sustainability performance within public healthcare institutions in Pakistan. A survey-cum questionnaire method was employed for 334 respondents of employees of public healthcare institutions in the Punjab Province of Pakistan. It used structured questionnaires to measure digital leadership, sense of empowerment, techno-work engagement, and sustainability performance. Structural Equation Modeling (SEM) was performed on data to examine the proposed relationships among the variables. The findings of SEM showed that digital leadership positively influences employees’ sense of empowerment. Empowerment significantly predicted techno-work engagement and sustainability performance. Techno-work engagement also positively affected sustainability performance. Mediation analysis revealed that the sense of empowerment mediates the relationship between digital leadership and both techno-work engagement and sustainability performance. The findings demonstrate that digital leadership enhances employee empowerment, which in turn boosts techno-work engagement and sustainability performance in the public healthcare sector. Organizations should promote digital leadership practices to empower employees and achieve sustainable outcomes.

Keywords

digital leadership sense of empowerment techno-work engagement sustainability performance public healthcare structural equation modeling social cognitive theory

Introduction

With the rapid pace at which digital transformation is happening within the public health sector, the way health services are delivered, managed, and perceived has been reshaped.¹ In this regard, digital leadership—a form of leadership that accesses, leverages, and fully uses digital technologies for better organizational process performance and quality patient care—becomes highly important.^2,3 Rapid technological advancements pose challenges for healthcare organizations, making it crucial to understand how leadership can influence technology-driven engagement in support of sustainable organizational performance.

Drawing on Social Cognitive Theory (SCT),⁴ which centers on such interactions between personal factors, behaviors, and environmental contingencies, this study examines the processes through which digital leadership influences employee outcomes. Especially, SCT suggests that individuals learn and develop new behaviors mainly through observation and imitation within a social context.⁵ In public healthcare, leaders can model the effective use of digital tools that inspire employees and make them more in control and engaged. The notion of empowerment among health workers is a critical, yet underexploited, dimension of the dynamic. Empowerment can be conceptualized in terms of autonomy, competence, and perceived impact⁶ that influence worker interactions with technology applications for organizational goal contributions.^7,8 Indeed, it is only when a workforce feels empowered that it is likely to more meaningfully engage with digital tools and participate meaningfully in efforts toward sustainability—areas that are essential for the long-term viability of healthcare organizations.

There is limited empirical evidence supporting that digital leadership as an important approach that can facilitate empowerment in influencing techno-work engagement (a condition or feeling of pleasant and rewarding well-being that is marked by vigor, devotion, and immersion with regard to the use of technology at work) and sustainability performance (the synchronization of environmental and financial goals in the delivery of key business processes that optimize value) within the public healthcare context. Articulating this relationship is key to strategizing enhanced employee engagement and organizational sustainability in this era of digital disruption.

Therefore, the objectives of this research are: (a) to investigate the influence of digital leadership on employees’ sense of empowerment in public healthcare organizations, (b) to examine the direct impacts of the sense of empowerment on techno-work engagement and sustainability performance and also the impact of techno-work engagement on sustainability performance, (c) to investigate how the sense of empowerment mediates between digital leadership and techno-work engagement, and (d) analyzing the mediating influence a sense of empowerment would have on the relationship between digital leadership and sustainability performance. Public health leaders develop actionable insights into improving employee engagement with technology to enhance sustainability outcomes through empowerment strategies. The research embeds the SCT into the analysis of these relationships, therefore contributing to both a theoretical and practical standpoint. It will explain how digital leadership can model and facilitate the behavior of the employees for the highest level of technology engagement and better performance regarding sustainability. The outcomes will contribute to enabling public healthcare organizations to successfully address the challenges of digital transformation while paying attention to sustainability.

Theoretical Framework and Hypotheses Development

This study applied SCT theory as a theoretical base to investigate the above-mentioned relationships.

Social Cognitive Theory

Social cognitive theory is crucial for understanding and testing the dynamics between digital leadership, empowerment, techno-work engagement, and sustainability performance in the public health sector. According to this theory, personal factors, behaviors, and environmental influences interact continuously, leading to learning and behavioral changes within a social context.^4,9 In this setting, digital leaders act as role models through effective technology use and innovation.² Employees observe these leaders during the digital transformation process—called observational learning—and begin adopting similar attitudes and behaviors.^10
-12 This social learning leads to greater empowerment, characterized by feelings of autonomy, competence, and a sense of meaningful contribution to their roles.

As a result, an empowered workforce is expected to engage more deeply with technology—known as techno-work engagement—which is reflected in enthusiasm, dedication, and absorption in technology-related tasks.¹³ This increased engagement not only improves individual performance but also enhances the organization’s sustainability by fostering practices that ensure long-term viability and efficiency.^14,15 The reciprocal nature of SCT implies that employees empowered and engaged will exercise an influence on the organizational environment to further reinforce innovation and sustainability culture. Thus, the theory explains how digital leadership shapes employees’ feelings of empowerment through the social learning process, leading to techno-work engagement and enhancing sustainability performance. By understanding these relationships, public healthcare organizations can better harness the benefits of digital leadership in facilitating an empowered and engaged workforce that is capable of sustaining definite change in an evolving technological landscape.

Digital Leadership and Sense of Empowerment

Digital leadership is defined as “the strategic use of digital technologies by leaders to attain better organizational performance” or, in other words, as “the use of information technology to create value and promote organizational performance.”² A leader who effectively integrates digital tools into organizational processes contributes positively not only to enhancing organizational efficiency but also to changes in attitudes and perceptions among employees.¹⁶ SCT suggests that people learn and accept new behaviors by observing and imitating role models within their environment.⁴ In this case, the digital leaders take the role of a role model who acts confident and competent in the use of digital technologies, making it a standard to be followed by employees.

This is an enabling environment created when leaders themselves get engaged with digital innovations and encourage the use of learning and experimentation.¹⁷ This environment influences the employee’s sense of empowerment by fostering an increased perception of autonomy, competence, and impacting organizational outcomes. According to Johnston et al.,¹⁸ the need for empowerment in the public health context is instrumental because most employees work under conditions where rapid technological changes have taken over, alongside increasing demands for efficiency in digital matters. In modeling positive attitudes toward the use of technology, digital leaders can reduce the discomfort felt about the use of technology and help build employee confidence in their ability to adopt innovative, digital tools. Empirical studies have supported this view that leadership behaviors are crucially important in influencing empowerment. For instance, Rao Jada et al.¹⁹ investigated that leadership empowered employees for innovation. In a healthcare setting, a supportive leadership/managerial style has also been shown by Biancone et al.²⁰ to facilitate nurses’ adoption of electronic medical records by increasing their perceived ease of use and usefulness of the technology. Therefore, based on SCT support and supporting literature, the following hypothesis has been proposed:

Hypothesis 1: Digital leadership is positively linked with employees’ sense of empowerment in public healthcare organizations.

Sense of Empowerment, Techno-Work Engagement, and Sustainability Performance

According to the SCT established by Bandura in 1986, individuals learn and develop a certain behavior through the interaction of personal factors, behavioral patterns, and environmental factors. In work environments provided by public healthcare organizations, empowerment is derived when employees form perceptions regarding their autonomy, competence, and capability to influence outcomes in the environment in which they operate.¹ The empowered state is made possible by observational learning and social contact, in which employees internalize the behaviors and attitudes modeled by leaders and peers. The greater sense of empowerment of workers will entice them or involve themselves more in the technological aspects of doing work,¹⁸ which may translate into higher techno-work engagement. According to the SCT, an empowered person decides to be self-directed and proactive by seeking every opportunity to apply and extend their skills.

In a healthcare setting, this means that empowered workers are more likely to accept new technologies, participate in digital initiatives, and inculcate technological tools into their daily activities.¹ This proactive engagement with technology amplifies their enthusiasm, commitment, and absorption in techno-centric work activities.^21,22 This is theoretically linked through several empirical studies. For instance, the study by Fernandez and Moldogaziev²³ establishes that employees who experience empowerment exhibit more innovative behaviors and adaptability in the use of technology. In healthcare settings, this form of empowerment has been known to lead to higher levels of utilization and acceptance in health information systems among other technological advancements recommended for them.¹⁸ Based on the SCT framework and relevant empirical evidence, we hypothesize as follows:

Hypothesis 2: Employees’ sense of empowerment is positively linked with techno-work engagement in public healthcare organizations.

Within the context of Social Cognitive Theory, individuals act on and are influenced by their environment where the idea of reciprocal determinism is considered. Employees in these healthcare organizations, when empowered, believe that their hard work counts, and their contribution makes a difference and can matter to organizational performance, such as sustainability performance.²⁴ Empowered employees are more likely to engage in behaviors that aim toward or directly impact environmental, social, and economic sustainability because they perceive such efforts as within their sphere of control to create change. Using observational learning, they may learn and share sustainable behaviors they observe in their leaders and peers, leading gradually over time to large improvements in the organization’s sustainability performance.

In support of this theoretical approach, some studies have established that there is a significant relationship between empowerment and employees’ motivations to engage in activities related to sustainability. For instance, Cheng et al.²⁵ described how empowered employees shared more willingness to engage in pro-environmental behavior and espoused organizational sustainability initiatives. Based on the Social Cognitive Theory and other empirical findings, we develop the following hypothesis:

Hypothesis 3: Employees’ sense of empowerment is positively linked with sustainability performance in public healthcare organizations.

Techno-Work Engagement and Sustainability Performance

Technology at work engagement—described as the degree of enthusiasm, dedication, and absorption that employees exhibit when interacting with technology in the workplace¹³ would be a key driver for sustainability performance. As stated by SCT, engaged employees act more actively in their environment, using technological tools to do their jobs better and increase their organizational outcomes. Techno-work engagement befits the SCT conceptualization of reciprocal determinism, as the behaviors themselves interact with and are influenced by the organizational environment. In return, with full engagement in technology, one is most likely to witness employees adapt digital tools for better practices of workflows and innovation processes that are environmentally sustainable.^26
-28 In this regard, healthcare professionals applying the work engagement concept can make better use of electronic health records (EHRs) to minimize paper flow, thus improving data accuracy and contributing to environmental sustainability coupled with operational efficiency.

Moreover, techno-work engagement fosters a culture of continuous enhancement and proactively solves problems,²⁹ which is an important element toward the realization of sustainability goals. The engaged employees are motivated to implement and discover such sustainable practices as energy-saving measures, strategies for waste reduction, and adoption of green technologies. This proactive stance enhances not just the sustainability performance of the organization but also strengthens the supportive environment that values and rewards sustainable behaviors. Empirical evidence supports the positive relationship between work engagement and sustainability performance. For example, studies by Çop et al.³⁰ demonstrate that work-engaged workers exhibit more green team resilience. The following hypothesis proceeds based on the theoretical support and available empirical literature.

Hypothesis 4: Techno-work engagement is positively linked with sustainability performance in public healthcare organizations.

The Mediating Role of Sense of Empowerment

SCT posits that people learn and acquire certain behaviors by observing role models in their social circle.⁴ In the context of public health organizations, digital leaders function as role models where technology utilization creates an innovative atmosphere that helps the employees capture changes. Leaders will be watched in their approach to digital transformations and spread a ripple effect in attitude toward technology adoption.² However, the impact of digital leadership on employees’ techno-work engagement is not solely direct, it is mediated through the employee’s sense of empowerment. A sense of empowerment links observation, and internalization of the behaviors modeled by digital leaders, to translate into personal engagement with technology. Empowered employees are autonomous, competent, and capable of influencing outcomes.³¹ According to the SCT, this empowerment will enhance their disposition to engage actively with technological tools. If an employee does not feel a sense of empowerment, they can be aware of digital leadership, yet they may not feel confident or motivated enough to apply any technological innovations in their work.

Several empirical studies have identified the mediating function of empowerment: for instance, Adeel et al.³² found the mediating role of psychological empowerment on the relations between social networks, job dedication, and individual creativity. Similarly, Khan et al.³³ established that empowerment was a mediator of the influence of servant leadership on innovative work behavior. Based on the SCT and support in the literature, we can propose the following mediating hypothesis:

Hypothesis 5: The sense of empowerment mediates the link between digital leadership and techno-work engagement in public healthcare organizations.

According to SCT, leadership behaviors and attitudes also have powerful effects on employee behaviors through observational learning.⁴ Leaders in digitized companies are concerned about the issues of sustainability model behaviors employees can adopt.³⁴ However, for a clear understanding of how these observed behaviors can be converted to improved sustainability performance, employees have to be empowered to take action.²⁵ A sense of empowerment gives the employees confidence and motivation to take part in these sustainability efforts.³⁵ Empowered employees believe that they are capable of making a meaningful impact on environmental and organizational outcomes. This is so critical in the public healthcare sector, where most of the sustainability initiatives require joint effort and proactive participation.³⁶ Otherwise, mere awareness about the issue of sustainability, without feeling empowered, may make them feel like they can’t do anything about it.

The empirical evidence of this mediating effect is very important. For example, Zafar et al.³⁷ found that environmentally specific servant leadership was significantly related to voluntary pro-environmental behavior through the mediating effects of empowerment. Therefore, combining SCT and considering the empirical findings, this study postulates the following hypothesis:

Hypothesis 6: The sense of empowerment mediates the link between digital leadership and sustainability performance in public healthcare organizations.

Research Methodology

The study was done in the public health sector in the megacities of Punjab province of Pakistan, focusing on employees and their immediate supervisors to explore the proposed relationships. A systematic random sampling technique was utilized to get a representative sample from the larger population in the sector. It involves the selection of participants at fixed intervals from a list that is drawn from an ordered population, making the sample more random and representative without necessarily having prior knowledge of the total population size.³⁸

Study Design

Consistent with the past studies,^39
-41 this research applies a cross-sectional survey design, in which data were gathered at 1 single point in time. Such a design is appropriate for testing relationships among variables since it allows taking stock of correlations, but also possible causal links, within the existing context for organizations. For this reason, the study aimed to take a snapshot of the current state of digital leadership, sense of empowerment, techno-work engagement, and sustainability performance for public health employees.

Sampling Technique and Inclusion Criteria

The sampling frame was made up of diverse public health institutions in big cities of Punjab, where employees were directly related to technological systems: for example, clerks at the front desks, technicians, and paramedics. Inclusion criteria required that participants be full-time with at least 1 year of experience within their current role for familiarity with organizational practices and technological tools. Using systematic random sampling, every fifth employee was chosen from the roster of employees that were to participate, based on the overall availability of participants and the sample size to be attained. This method minimizes selection bias, as every member of the population is accorded an equal opportunity for inclusion in the research.⁴²

Data Collection Procedure

The data collection was outsourced to a reputable survey firm that strictly observes accuracy, confidentiality, and adherence to ethical standards. These firms were considered fitting for the technological nature of the study, in addition to the widespread access to the Internet among the target population. The invitations to participate in this study were extended to 486 eligible employees. The purpose of the study was explained, confidentiality was assured for the participants, and instructions on how to complete the online questionnaire were provided. Ethical approval was obtained from respective official review boards before data gathering. Participants provided informed consent before starting the survey.

The participants were told that it was voluntary participation, responses would be kept confidential, and data reported in aggregate form without identifying respondents. The measures of demographic characteristics, perceptions of digital leadership, sense of empowerment, techno-work engagement, and sustainability performance were used in the survey. The appropriate scales from the relevant literature were used in the context of the public healthcare sector for this study. Altogether, 351 questionnaires were returned, yielding an estimated response rate of approximately 72.2%. Following the screening for completeness of responses, 17 questionnaires were incomplete or invalid due to missing data or response patterns suggesting a lack of engagement—for example, straight-lining. These were excluded from the analysis, leaving a total sample size of 334 participants.

Measurement Scales

We modified items from recognized scales to suit the research setting to measure the key structures. All measurement scales were validated in the past studies. The responses were categorized on a 5-point Likert scale (1-strongly disagree, 5-strongly agree) which is consistent with earlier studies.^43
-45 The survey for this study was split into 2 portions. The first segment contains questions regarding the participants’ demographics. The second segment assesses participants’ perceptions of digital leadership (6 items), sense of empowerment (3 items), techno-work engagement (9 items), and sustainability performance (7 items). All items and their sources are mentioned in Table 1.

Table 1.

Loadings, composite reliability, average variance extracted, and study items.

Measures	Loadings
Digital leadership¹⁷: (CR = 0.906, α = .904, AVE = 0.616)
1. My digital leader raises the awareness of the employees of the institution about the risks of information technologies.	0.796
2. My digital leader raises awareness of the technologies that can be used to improve organizational processes.	0.734
3. My digital leader determines the ethical behaviors required for informatics practices together with all its stakeholders.	0.844
4. My digital leader plays an informative role to reduce resistance to innovations brought by information technologies.	0.719
5. My digital leader shares his/her own experiences about technological possibilities that help his/her colleagues to learn about the organization’s structure.	0.779
6. In order to increase participation in the corporate vision, a digital leader guides the employees of the institution regarding the technological tools that can be used	0.829
Sense of empowerment³⁵: (CR = 0.831, α = .830, AVE = 0.621)
1. My organization gave me the feeling that I was involved in the event service development process.	0.795
2. My organization customized or would customize the services based on my personal needs.	0.786
3 My organization added or would add some additional services based on my request.	0.783
Sustainability performance^46,47:: (CR = 0.913, α = .912, AVE = 0.599)
1. As an organization, we know enough about corporate sustainability.	0.812
2. Our operations are based on sustainable growth, social responsibility and environmental protection.	0.812
3. Our attitude is that sustainability is one of the essential components of corporate culture.	0.723
4. We exploit environmental challenges and legislation to our advantage by developing new, greener products.	0.802
5. Ecological regulations restrict our organization.	0.716
6. Due to ecological constraints, we are considering relocating production to countries where ecological requirements are lower.	0.774
7. Sustainability is viewed as an important route for the long-term development of the enterprise.	0.773
Techno-Work Engagement⁴⁸:: (CR = 0.930, α= .930, AVE = 0.597)
1. I feel strong and vigorous when I use technology in my job.	0.774
2. I always persevere with using technology in my work, even when it does not go well.	0.785
3. I am enthusiastic about utilizing technology in my job.	0.762
4. Utilizing technology inspires me in my job	0.811
5. I am proud that I utilize technology in my work	0.765
6. I feel happy when I am immersed in using technology in my work.	0.774
7. I am completely immersed in using technology in my work.	0.802
8. I get carried away when I’m working with technology	0.768
9. When I utilize technology in my work, I feel that I am bursting with energy	0.710

Note. All factor loadings are significant at the P < .001 level.

Data Analysis and Results

The data from this study were analyzed via Statistical Package for Social Sciences. The IBM SPSS Statistics for Windows, version 23 (IBM Corp., Armonk, N.Y., USA) and AMOS were utilized for the descriptive statistics, confirmatory factor analysis (CFA), and hypotheses testing.

Valuation of the Measurement Model

This scholarship followed the 2-step method suggested by Anderson and Gerbing.⁴⁹ The 2-stage technique comprises confirming the measurement model and evaluating the structural model in the second stage. First, following the most recent recommendations provided by Hair et al.,⁵⁰ individual item reliability, construct reliability (CR), convergent validity, and discriminant validity were used to evaluate the suitability of the measurement model for each of the 4 variables. To measure the reliability of individual variables, outer loadings must be >0.70.⁵¹ Table 1 shows outer loadings ranging from 0.710 to 0.844. Outer loadings in all 4 variables are adequate, indicating satisfactory reliability. Second, to support internal consistency or construct reliability, α and CR values must be >0.700. The α and CR values for all 4 variables range from 0.830 to 0.930 and 0.831 to 0.930, respectively (see Table 1). These numbers demonstrate that all 4 factors exhibit appropriate levels of reliability, indicating construct reliability. Third, convergent validity requires values of AVE > 0.500 for each dimension.⁵¹ All AVE values fell within the range of 0.597 to 0.621 (see Table 1). These results show that all 4 variables had an adequate level of AVE, supporting convergent validity. Finally, to determine discriminant validity, this study investigated the criteria established by Fornell-Larcker and the heterotrait-monotrait (HTMT) ratio. All 4 variables had HTMT values smaller than 0.85, indicating that the HTMT requirement was met to a high degree.⁵¹ Moreover, Table 2 confirms the Fornell-Larcker criteria, as the square root of AVE for every factor exceeds its correlation in model.⁵¹ These 2 criteria thus support discriminant validity. Table 2 provides the details about descriptive statistics and the correlation matrix between the variables.

Table 2.

Descriptive statistics, correlations, and the square root of the AVE.

Variables	Mean	SD	1	2	3	4	5	6	7
1. Gender	0.56	0.50	-
2. Age^a	34.01	8.20	−.05	-
3. Experience^a	9.90	5.88	−.06	.29^***	-
4. Digital Leadership	3.73	0.71	.03	.06	.07	(0.79)
5. Sense of Empowerment	3.71	0.82	−.04	.04	.03	0.38^***	(0.79)
6. Techno-work Engagement	4.52	0.90	−.07	−.02	−.03	.54^***	.54^***	(0.78)
7. Sustainability Performance	3.64	0.72	−.07	.04	.01	.60^***	.44^***	.53^***	(0.77)

Note. N = 334. Diagonals (in bold) denote the square root of the AVE. a = age and experience are in years.

***

P < .001.

Common method bias (CMB) can occur when a single method measures multiple factors, leading to biased outcomes. The study used a dual strategy to overcome this issue. The initial step involved implementing Harman’s single-factor test. This test determines if a significant part of data variance can be attributable to a single source. This analysis found that only 40.15% of the variance could be attributed to a single factor, which is significantly lower than the benchmark of 50.00%. This suggests that there was no CMB. The study used Kock’s⁵² comprehensive collinearity test. The possible existence of CMB was assessed using variance influence factors (VIFs). All tested latent constructs had VIFs below the 3.30 threshold, indicating no significant CMB. Moreover, model fit results of CFA for the measurement model provided a satisfactory fit for example RMSEA = 0.050, CFI = 0.959, TLI = 0.954, and Normed X² = 1.821.

Valuation of the Structural Model

The structural equation modeling (SEM) approach was utilized to test the studied model. Model fit results of CFA for the structural model provided an adequate fit, for example, RMSEA = 0.060, CFI = 0.938, TLI = 0.931, and Normed X² = 2.217. The results of the hypothesis testing related to direct effects are shown in Figure 1. Figure 1 shows that all parameter estimates for direct relationships are both statistically significant and in the predicted direction. The findings from these direct relationships verify that there is a significant and positive link between digital leadership and employee sense of empowerment (H1: β = .54, P < .001), and sense of empowerment significantly predicted techno-work engagement (H2: β = .66, P < .001) and sustainability performance (H3: β = .33, P < .001). Similarly, techno-work engagement is a significant predictor of sustainability performance (H4: β = .37, P < .001), supporting all 4 direct hypotheses.

Figure 1.

Hypotheses testing.

Bootstrapping with 10 000 subsamples was used to evaluate the sense of empowerment mediating influence. This study specifically examined the indirect effects of digital leadership on techno-work engagement through a sense of empowerment. Results indicate digital leadership had significant indirect effects on techno-work engagement (H5: indirect effects = 0.15, P < .001, CI 95% [0.06, 0.24]) as there is no zero involved in the upper and lower limits of the confidence intervals (see Table 3), this hypothesis supported by this finding. This study then tested the indirect effects of digital leadership on sustainability performance. Table 3 shows that digital leadership has a strong indirect effect on sustainability performance via employee sense of empowerment (H5: indirect effects = 0.09, P < .001, CI 95% [0.03, 0.17]), supporting hypothesis 6 as well.

Table 3.

Mediation analysis.

Hypotheses	β	LL	UL
Digital Leadership → SoE → Techno-work Engagement	.15***	0.06	0.24
Digital Leadership → SoE → Sustainability Performance	.09***	0.03	0.17

Note. SoE = sense of employment; LL = lower level; UL = upper level.

***

P < .001.

Discussion

The present study was proposed to assess the associations among digital leadership, sense of empowerment, techno-work engagement, and sustainability performance in the public healthcare sector, in Punjab, Pakistan. Using SEM, results provide sound support for all the hypothesized associations regarding the important role of digital leadership and employee empowerment in enhancing organizational outcomes. The results reveal a positive significant relationship between employees’ sense of empowerment and digital leadership. This finding is consistent with the assumptions of the Social Cognitive Theory which suggests that individuals learn and use behaviors that they obtain through observing role models around them.⁴ In this context, digital leaders become role models and they model practices of good use of technology and create an environment that engenders autonomy, competence, and impact. Thus, leaders empower the employees to be confident in embracing digital tools, this finding is consistent with recent studies where digital leadership was a significant predictor of employee-related outcomes.^2,53

The empirical results also reveal that empowerment is a significant predictor of techno-work engagement and sustainability performance. The results suggest that the employees, once empowered, become more enthusiastic and fully absorbed in the respective technology-related tasks, which in turn increases their engagement level. This is in line with the prior research evidence indicating that psychological empowerment is taken as one of the critical antecedents of work engagement.⁵⁴ Moreover, the empowered employees would participate more in sustainability engagement as a result of perceiving their actions to potentially contribute to the organizational goals and purposes of the organization accordingly.³⁷

In addition, techno-work engagement significantly predicted sustainability performance, which underscored the significance of employee technological engagement to reach sustainable organizational outcomes. This finding underpins suggestions that employees who are engaged technologically are best placed to apply innovative solutions that enhance the environmental, social, and economic performance of an organization.⁵⁵ Moreover, the results of the mediation analysis showed that a sense of empowerment mediated the relationship between digital leadership and techno-work engagement, and sustainability performance. These indirect effects were significant, which evidences that empowerment is one of the important mechanisms by which digital leadership exerts an influence on such outcomes. This is in congruence with the view espoused by SCT of reciprocal determinism wherein personal factors, behavior, and environment interact with one another in a dynamic manner.⁴ These results are consistent with the findings of past studies that investigated the mediating role of empowerment in similar settings with other variables.^32,33,37

Implications for Theory

The findings of the current study represent a significant contribution to the theoretical understanding of studied variables through the lens of SCT. The current study confirms the application of SCT in the setting of digital leadership for public healthcare organizations. Firstly, this study further consolidates the assertion from SCT that individuals learn and adopt behaviors through observation and social interaction within their environment,^4,9 by showing that digital leadership positively influences employees’ perceptions of empowerment—and in turn, techno-work engagement and sustainability performance. Empirical support, therefore, underlines the relevance of the theory in explaining how leadership behaviors can drive employee attitudes and subsequent actions in technologically advanced organizational settings. Secondly, the current study also extends SCT by underlining the role of a sense of empowerment as a mediator in the relationship between leadership and employee outcomes. Insofar as the center of attention in SCT is observational learning and modeling, the present study highlights how empowerment works internally as a psychological mechanism that translates observed leadership behaviors into personal drives and engagement. It integrally enhances theoretical insights by showing that empowerment is actually not an outcome but a source that plays a significant role in the process of behavior adoption and sustaining engagement with technology and organizational goals.³²

Finally, it contributes to the literature in linking SCT to specific organizations’ outcomes, such as techno-work engagement and sustainability performance. This extends the theory from individual learning to collective organizational behaviors and performance metrics by applying SCT in explaining how such outcomes are influenced by leadership and empowerment. This, therefore, intimates that SCT is capable of explaining complex organizational phenomena involving technological adoption and sustainability initiatives for future studies examining similar constructs.

Implications for Practice

These insights are of great importance to any public health organization seeking to improve employee engagement and organizational performance. The significant relationship of digital leadership to employee empowerment and, consequently, engagement underlines the need for organizations to invest in the development of digital leadership competencies. Training programs should be designed to enable leaders to develop skills in effectively modeling the use of technology, creating an innovative atmosphere, and leading by clearly communicating digital initiatives.^2,16 The more digitally leading an organization becomes, the ripples that spread will boost overall employee empowerment and engagement. Empowerment, in its role as a mediator, suggests that organizations should implement strategies aimed at increasing employees’ autonomy, competence, and impact. This can be achieved by promoting participative decision-making, offering professional development opportunities, and recognizing individual contributions to technological and sustainability initiatives.³² An enabling work environment fosters increased techno-work engagement, making employees proud of their role in sustainability practices, which in turn enhances organizational performance and resilience.

Besides, the positive association between techno-work engagement and sustainability performance indicates that by leveraging employees’ technological engagement, organizations can drive progress toward accomplishing their sustainability-related objectives. Organizations will henceforth be able to align technological advancement with environmental responsibility by integrating sustainable practices into technological platforms,⁵⁶ for example, embedding energy-saving systems, promoting telemedicine to reduce carbon footprints, or using digitized record-keeping to reduce paper usage. Boosting innovation among employees in applying technology for sustainability purposes could have cost-saving advantages, improve the company’s image in the public eye, and meet regulatory requirements. Furthermore, customized e-learning and workshops on digital skills training programs can enhance employee empowerment and engagement in public healthcare. Incentive systems and digital tool usage integrated into performance reviews also help to strengthen technology adoption. Human-AI competencies through AI literacy initiatives build staff preparedness for the next development. Possible problems, such as resistance to change and shortage of resources, may be minimized by clear communication of the revised process, and by involving employees in decision-making using low-cost means of training whenever possible. Finally, this study provides public health organizations with actionable recommendations for improvement in leadership practices, building employee empowerment, and technological engagement that supports the achievement of sustainability goals. With these focuses, management can work toward betterment not only in operational efficiency but also in contributing toward wider societal objectives that in turn may lead to a more sustainable and engaged workforce.

Limitations and Future Research Avenues

Although this study provides some insights into how digital leadership, a sense of empowerment, techno-work engagement, and sustainability performance all interrelate with one another within the public healthcare sector, there are a few limitations that have to be recognized. First of all, it is based only on Social Cognitive Theory, yet presents only a single theoretical frame for analysis. This study did not integrate other related theories such as the Technology Acceptance Model (TAM), Unified Theory of Acceptance and Use of Technology (UTAUT), Organizational Change Theories, or the Resource-Based View (RBV). Given that these were not considered, this limits the multidimensional nature of understanding the interaction between technology adoption, leadership, and organizational change. Future research can attempt to integrate such frameworks to investigate other antecedents of employee engagement with both technology and sustainability-related issues. For instance, both TAM and UTAUT focus on perceived usefulness and ease of use as crucial factors in analyzing individual acceptance and usage of technology,^57,58 which could give new insights into techno-work engagement. Theories of Organizational Change can provide a broader context in which digital leadership facilitates change management processes, while RBV can shed light on how empowered employees act as strategic resources contributing to competitive advantage. Our decision not to use these theories was based on the study’s objective to focus on the mechanisms provided by SCT, particularly the role of observational learning and reciprocal determinism in shaping employees’ behaviors. Focusing our research on SCT allowed for a clear-cut analysis, not confounded by an integrated multi-model theoretical framework. However, this choice inherently limits the generalizability of our findings and may overlook other relevant variables and relationships that could be revealed by other theories.

Another limitation relates to the potential for social desirability bias in self-reported measures, particularly regarding attitudes toward leadership and empowerment, future studies should consider using more indirect questioning techniques to mitigate this effect. Moreover, the study did not conduct measurement invariance testing across job roles or institutions. Upcoming studies could examine measurement invariance to check consistency in responses across different subgroups.

The cross-sectional strategy of the scholarship further limits the findings of this study because no causal inferences can be drawn. Data collected at 1 point in time cannot capture the dynamic relationships between variables or changes over time. Longitudinal studies are suggested to see how digital leadership and empowerment influence techno-work engagement and sustainability performance over time. These designs would better explain the causality and temporal sequence of events. Finally, the study was conducted within a specific cultural and organizational environment of public healthcare institutions in Punjab, Pakistan. The cultural factors of this region, coupled with organizational structures, may limit the generalizability of the conclusions to other contexts.⁵⁹ Cultural dimensions such as power distance, collectivism versus individualism, and uncertainty avoidance have a significant influence on leadership practices and employee behaviors.⁶⁰ Therefore, the results should not be generalized across cultures or different organizational settings without caution. Replicating the study in various contexts will enhance its external validity and allow for cross-cultural comparisons.

Footnotes

Availability of Data and Materials

Data for this study can be attained on the request from the corresponding author.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Ethical Approval

All procedures performed in studies involving human participants were following the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethical approval was taken from the ethical committee of participating organizations.

ORCID iDs

Ali Nawaz Khan

Yumei Wang

Ali Ahmad

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