Purpose Leadership has emerged as a pivotal force in driving the adaptation and effectiveness of complex health and care systems. However, no evidence synthesis exists regarding empirical research which applies the lens of complexity science to understand the phenomenon of leadership in health and social care contexts. The aim of this secondary analysis was to provide a further insight into how complexity science has been applied to the concept of health and social care leadership. Design/methodology/approach A secondary analysis of a scoping review of primary health and social care research using complexity-informed approaches, with a specific focus on leadership, was performed. Findings Research included diverse categories of leaders including multidisciplinary care teams, nurses and parents. Methods varied in their approach, including qualitative, quantitative and case study design, as well as engagement with the principles of complexity. Complexity science was commonly applied as an underlying theoretical framework in research which examined change implementation or their organisational setting. Originality/value This secondary analysis highlights the limited evidence regarding how complexity has been applied in the context of health and social care leadership research. The findings of this review warrant further implementation and research of complexity science principles to understand how to support and the effects of amongst health and social care professional leaders within complex adaptive systems. As health and social care systems are increasingly being encouraged to provide integrated care, it is important to examine the ways in which complexity science has been applied within health and social care leadership.

Purpose The primary purpose of this systematic literature review is to provide a global, comprehensive and up-to-date synthesis of physicians’ perspectives on barriers to and facilitators of physician leadership. Design/methodology/approach This review included peer-reviewed empirical articles and dissertations/theses published in English from January 2014 to June 2024 examining the barriers to and/or facilitators of physician leadership from physicians’ perspectives, either as primary objectives or emergent findings. A comprehensive search was conducted across 10 databases, including PubMed, Embase, Web of Science, CINAHL and Scopus. Tools and frameworks such as the preferred reporting items for systematic reviews and meta-analyses (PRISMA) checklist, PRISMA flow diagram, SPIDER, Zotero, Rayyan and mixed methods appraisal tool (MMAT) were used to formulate research questions, screen studies, assess methodological quality and present the results. The findings were synthesized and organized into emergent themes. Findings The search started with 11,691 studies and ended with a final sample of 123 articles, comprising quantitative, qualitative and mixed methods designs. Three overarching themes were identified: individual-level, organizational-level and systemic-level barriers and facilitators. A total of 11 barriers (e.g. identity conflict, inadequate leadership training, negative perceptions about the physician leader) and seven facilitators (e.g. desire for influence and change, relational and practical support, health care reforms) were identified across studies. Research limitations/implications The findings from this review may guide researchers, policymakers and healthcare organizations to develop and implement multi-level evidence-based interventions to help motivate, support and retain physician leaders worldwide. Originality/value To the best of the author’s knowledge, this is the first systematic review to primarily explore barriers to and facilitators of physician leadership solely from physicians’ perspectives. By analyzing 123 studies across diverse healthcare systems and contexts, this review offers a global, comprehensive and up-to-date understanding of the individual, organizational and systemic factors influencing physicians’ decisions to pursue leadership.

Purpose This study aims to explore the impact of transformational, transactional and servant leadership on organizational success, with specific attention to the moderating role of technology adaptation and potential mediating role of organizational culture in the Iranian healthcare system. Design/methodology/approach A quantitative, cross-sectional survey was conducted with 340 healthcare professionals across public and private sector, using judgmental sampling and analyzing the data using correlation, regression analysis and PROCESS MACRO to test mediation and moderation. Findings Results confirm that leadership strategies, when considered as a composite construct have a statistically significant positive impact on organizational success, encompassing patient care quality, operational performance and employee engagement. Contrary to the theoretical expectations, the mediating role of organizational culture in this relationship was not supported, suggesting that cultural change may be less responsive to leadership efforts in bureaucratic healthcare systems. However, the study revealed that technological adaptation moderates the relationship between leadership and success, amplifying the effectiveness of leadership strategies in technologically adaptive environments. Originality/value By extending leadership theory to a non-Western, resource-constrained healthcare setting, this research contributes to the global discourse on healthcare leadership and highlights the importance external contextual enablers in enhancing leadership effectiveness. It also challenges the assumed universality of cultural mediation models in leadership theory.

Purpose This study aims to examine nurses’ leadership orientations, patient-centered care practices and the relationship between the two. Design/methodology/approach Descriptive research design was used in this study. The study population consisted of 349 nurses working in adult wards of a university hospital in Turkiye. Data were collected between August 2021 and September 2021 using the “Individual Information Form”, “Multidimensional Leadership Orientations Scale (MLOS)” and “Patient-Centered Care Competency Scale (PCCS)” with 185 nurses who agreed to participate in the study. Findings The total PCCS score was 72.90 ± 8.23 and the total MLOS was 75.9 ± 10.69. A positive, moderate relationship was found between nurses’ leadership orientations and patient-centered care competencies. Research limitations/implications The study population consisted of nurses (N = 349) working in adult wards at a university hospital. The sample consisted of nurses working in adult medical and surgical units who were selected by simple random sampling and volunteered to participate (n = 185). Nurses working in pediatric units, where a family centered care approach is prominent, were excluded from the study to focus on patient-centered care. Practical implications In practice, organizations should align patient-centered care training with unit-level leadership programs; they should standardize “participation-encouraging” behaviors through phased development models for unit managers and clinical nurses. This approach can create a sustainable foundation for improving patient experience and team functioning. Originality/value Although there are many studies on the concepts of leadership and patient-centered care (PCC) in the literature, only a limited number of studies have examined the role of leadership in the context of PCC. In existing studies, leadership has been examined from the perspective of managers or nurse educators, not nurses. Our study fills this gap in the literature by offering a different perspective for both healthcare managers and nurses. Beyond aligning with recent evidence on education and mentorship effects on PCC, this study adds novel nurse-level quantitative evidence linking structural and political leadership orientations with the “promoting patient involvement” and “providing patient comfort” patient-centered care subscales.

Purpose Changing healthcare organizations call for more collective and team-based approaches to leadership. This study focuses urgent care units in Sweden where unit managers and physicians responsible for medical management are expected to co-lead as equals in the organizational hierarchy in a form conceptualized as functionally shared leadership (FSL). This study aims to increase the current scientifically based knowledge about putting FSL into practice. Design/methodology/approach Data was collected through interviews on two occasions with individuals in couples leading six publicly driven urgent care units, and through conversations with the department manager of these units. Data was analyzed in two steps, first with individuals and second with pairs as the basis of analysis. In step 1, an iterative, thematic approach was used. In step 2, the theoretical points of departure served as a lens to direct our focus. Findings Amid handling ordinary work tasks and new challenging situations, the couples worked to shape a shared leadership space. Three intertwined activities were identified: working with boundaries, working with structures and relating to each other. The presence of a shared purpose emerged as the glue of co-leading. Metaphorically the couples perform a co-leadership dance where the steps of either influence the other. Originality/value The study contributes knowledge relevant for healthcare contexts as well as to the research field of managerial shared leadership concerning cross-functional sharing. It adds understanding of previously understudied informal and processual aspects. The shaping of a shared leadership space is not a separate activity with ready-made mandates.

Purpose The purpose of this study is to explore hospital managers’ experiences and reflections concerning the influence of working conditions on nursing staff’s infection prevention behaviours and strategies used by the managers to promote infection prevention work among staff. Design/methodology/approach The qualitative study uses a reflexive thematic analysis. Six first-line and five second-line managers at surgical and orthopaedic hospital units were interviewed. Findings Reflecting a balance between resources and responsibility in promoting infection prevention behaviours, four themes were generated: (1) being attentive to staff needs and taking action in a changing healthcare environment, where managers adjust working conditions to minimise interruptions and manage workload; (2) bultivating a positive work climate for both the team and the individual, emphasising team collaboration and role modelling in infection prevention; (3) providing resources for knowledge development and understanding, including appointing hygiene representatives and promoting accessible infection control information; and (4) promoting personal responsibility for compliance and infection-safe workflows, highlighting staff responsibility regardless of working conditions. Originality/value This study provides new insights into hospital managers’ perspectives on how working conditions influence nursing staff’s infection prevention behaviours and the strategies managers use to support compliance. Unlike prior research focused on frontline staff, this reflexive thematic analysis highlights the managers’ role in balancing organisational support with staff accountability, offering valuable insights into infection control in complex healthcare environments.

Purpose This study aims to explore the relationship between resilient leadership and organizational resilience in Ugandan healthcare systems, focusing on the mediating role of nurses’ well-being. Given the high-stress nature of healthcare, fostering organizational resilience through effective leadership and nurses’ well-being is crucial for sustaining quality service delivery. Design/methodology/approach A quantitative survey was conducted with 209 nurses across various healthcare facilities in Uganda. Data analysis was performed using the partial least squares (PLS) approach to examine the direct and mediating relationships between resilient leadership, nurses’ well-being and organizational resilience. Findings The results reveal that nurse well-being significantly mediates the relationship between resilient leadership and organizational resilience. This suggests that resilient leadership positively influences nurses’ well-being, which in turn enhances the overall resilience of healthcare organizations. Practical implications The study highlights the importance of integrating well-being initiatives into leadership strategies to strengthen healthcare institutions. Healthcare leaders should prioritize nurses’ well-being as a core component of resilience-building efforts. In addition, policymakers should support the implementation of well-being programs and leadership development initiatives to enhance organizational sustainability in healthcare. Originality/value This study contributes to the growing body of knowledge on resilience in healthcare by providing empirical evidence on the mediating role of nurses’ well-being. It underscores the significance of employee-centered leadership in fostering organizational resilience, particularly in resource-constrained healthcare systems.

Purpose Despite its significant potential to bridge and integrate, co-leadership is known to be fragile – a graphic in an organigram that doesn’t transmit reality or illustrate the paralysis of tensions. Moments of transition, including changes in co-leaders, render the arrangement particularly vulnerable. Yet, we know little about how to maintain the stability of co-leadership arrangements. This study aims to explore that shortcoming in the context of frequent co-leader transitions. Design/methodology/approach Data was collected during a longitudinal qualitative study of co-leadership – the sharing of a leadership role by two individuals – in a military healthcare organization, where a context of frequent personnel rotations gives rise to almost yearly leadership transition events. An inductive analysis of 32 semistructured interviews with tactical-level co-leaders revealed three main factors contributing to the stability of this model, which has been in place for over 20 years. Findings In this case, the stability of co-leadership is rooted in three elements. First, similar structural arrangements and traditions are widely practiced and accepted within the field. Second, there is a common understanding that roles and relationships are negotiated on a temporary basis. Third, patterns of distancing contribute to maintaining the existing state. Originality/value The ongoing replacement of leaders in an established co-leadership structure made for a unique and extreme case of instability, revealing the paradox of stability: in this case, the stability of the arrangement derives from the instability of its membership and from a shared view of its inner workings as a temporary modus operandi.

Purpose This study aims to develop a theory-informed typology of rural health workforce development interventions specific to Federally Qualified Health Centers (FQHCs). Guided by Bronfenbrenner’s Social Ecological Model, and using a PRISMA-based systematic review, this paper synthesizes the types, characteristics and strategic orientations of interventions implemented to support recruitment, training and retention of health professionals in rural and underserved settings. Design/methodology/approach A systematic review followed PRISMA 2020 guidelines, drawing on five academic databases (CINAHL, MEDLINE, Science Direct, PsycInfo and Health Source Nursing/Academic). Thirty-five peer-reviewed articles published between 2010 and 2025 were analyzed using thematic coding and constant comparative methods to identify intervention categories and key characteristics. Findings Five dominant types of rural workforce interventions were identified: (1) Educational Pipeline Programs, (2) Policy and Partnership Models, (3) Practice Environment Enhancements, (4) Community-Embedded Workforce Strategies and (5) Financial and Incentive-Based Strategies. Educational and policy-driven models were most frequently represented, while culturally grounded, community-embedded strategies were notably underutilized. The study reveals a field in transition – shifting from short-term incentives to sustainable, leadership-informed approaches. Originality/value This is the first study to develop a leadership-relevant typology of rural health workforce interventions in FQHCs. The framework offers policymakers, administrators and educators a practical tool for assessing strategies, identifying gaps and designing equitable, sustainable workforce solutions.

Purpose This study aims to examine how leadership approaches balancing structure with psychological safety influence team effectiveness in integrated healthcare leadership teams that span organisational boundaries. The research focuses specifically on an integrated mental health crisis service leadership team. Design/methodology/approach A qualitative intrinsic case study design was conducted as part of MSc dissertation requirements. The study reanalysed interview data (n = 8) alongside reflective notes, and team effectiveness measures from an integrated mental health crisis service leadership team. Reflexive thematic analysis identified structure-psychological safety relationships. Findings Reanalysis revealed three interconnected themes: clear parameters and boundaries, psychological safety within structure and structured development opportunities. Structured leadership approaches created conditions for psychological safety and team development rather than constraining them. Team effectiveness measures showed improvements, including role clarity (3.6 / 5.0–4.4 / 5.0), inter-team working (3.5–4.1), team innovation (4.2–4.7) and team objectives (4.0–4.6), though multiple factors likely influenced these changes. Research limitations/implications The single case study design limits generalisability but suggests avenues for future research into how systematic approaches complement psychological safety in integrated healthcare settings. The exploratory data reanalysis provides preliminary insights requiring validation across diverse contexts. Practical implications Healthcare leaders might benefit from examining how clear parameters enable rather than constrain team development across organisational boundaries, supporting current integrated care system initiatives. Originality/value This study contributes to conversations about structure and psychological safety relationships in leadership practice. It challenges assumptions that structure necessarily constrains psychological safety, suggesting structured approaches can create enabling conditions for team development in complex healthcare environments.