How leadership attention is associated with online–offline healthcare service synergy: differentiated effects of noticing, interpreting, and acting

Aim 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. Methods An exploratory sequential design was adopted. During the qualitative phase, data were triangulated from 41 interviews (hospital administrators, health bureau officials, clinicians), “Internet + Healthcare” 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’s internet healthcare users, yielding 450 valid responses from experienced professionals; data were analyzed with SPSS/AMOS (SEM) and PROCESS macro for moderation. Results The three attention types showed differentiated patterns. Acting had the strongest positive associations with process synergy ( β = 0.53, p < 0.001) and organizational synergy ( β = 0.50, p < 0.001). Noticing was positively associated with both ( β = 0.26 and β = 0.29, p < 0.001). Interpreting was only significantly associated with process synergy ( β = 0.15, p < 0.05), not organizational synergy. Credit claiming positively predicted all three attention types ( β = 0.78–0.87, p < 0.001); blame avoidance negatively predicted them ( β = −0.46 to −0.39, p < 0.001). Contextual factors positively moderated the attention–organizational synergy link ( β = 0.113, p < 0.01, 95%CI [0.02, 0.14]), with no moderation for process synergy. Conclusion 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.