Purpose This study aims to describe the themes of ethical challenges identified in healthcare leadership during and after the COVID-19 pandemic.Design/methodology/approach This review followed the Joanna Briggs Institute scoping review methodology. A systematic search was done in CINAHL, Scopus, Web of Science, ProQuest, Mednar, PubMed and the Finnish database Medic. The search was conducted from 2020 to 2025, as the scoping review focused on the period during and after the COVID-19 pandemic. Data was analysed using narrative synthesis. The review was reported using the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping reviews.Findings A total of 21 articles were included in the review: 11 research articles and 10 anecdotal articles. Five main themes of ethical challenges identified in healthcare leadership during and after the COVID-19 pandemic were: operating in a turbulent and unpredictable environment; digitalisation and the ethical use of technology; ethical considerations in leadership practice; staff competence and ethical awareness; and patient vulnerability and justice in care.Practical implications The findings suggest that organisations need to invest in leadership support, fair policies, workforce sustainability and ethical frameworks that evolve in tandem with technological advancements. Healthcare systems need to strive for greater clarity, purpose and alignment in their data-driven practices. There is a need for ethical training, mentoring and a culture of ethical reflection.Originality/value This review produced new, comprehensive information and valuable insights into the existing literature describing ethical challenges in healthcare leadership during and after the COVID-19 pandemic.
Purpose This study aims to explore how frontline managers (FLMs) in Norwegian municipal health care perceive the relevance and practical usefulness of the management competency assessment partnership (MCAP) competency model. While competency models are widely promoted to strengthen health-care management and leadership, fewer studies have examined how such models are experienced by FLMs who work under considerable operational and contextual constraints. Design/methodology/approach A qualitative study was conducted using three focus group discussions with 14 FLMs from three Norwegian municipalities. Before discussions, participants completed the MCAP questionnaire and reflected individually on its strengths, limitations and relevance. Data were analysed inductively using qualitative content analysis. Findings The analysis revealed two interrelated findings. First, FLM perceived MCAP as a relevant and comprehensive model that reflected the formal expectations for their role. Second, they questioned its practical usefulness when considered in relation to everyday work. Large spans of control, broad task scope, time pressure and limited room for manoeuvre constrained managers’ opportunities to develop, prioritise or enact several competencies. This was particularly consequential for interpersonal communication and change management, which were highlighted as the most important competencies by the informants. Originality/value This study contributes a conceptual lens for interpreting competency models as espoused theories and contrasting them with the theories-in-use that managers develop to meet everyday operational demands. It shows that competency mapping alone is no silver bullet for strengthening management. Effective competency development requires organisational conditions that enable FLMs to enact and sustain the competencies that models such as MCAP define.
Purpose This study aims to explore frontline and middle-management leaders' experiences of ethical leadership in health and social care and examine the prerequisites associated with its enactment in everyday work.Design/methodology/approach Semi-structured interviews were conducted with 16 health and social care leaders and analysed using Braun and Clarke's reflexive thematic analysis. The study adhered to the Standards for Reporting Qualitative Research and the Consolidated Criteria for Reporting Qualitative Research.Findings Five interrelated themes described the prerequisites for ethical leadership: its fundamental value-based nature; leaders' internal ethical capability; human interaction and trust; organisational structures and culture; and ethical agency within hierarchical systems. Ethical leadership was described as a central aspect of managerial work, grounded in client-centredness and professional integrity, yet its enactment was perceived to be constrained in contexts characterised by unclear strategic direction, hierarchical pressures and competing organisational demands.Practical implications Strengthening ethical leadership may require multi-level support addressing individual, relational and organisational conditions. Organisations can foster these prerequisites through coherent strategic direction, transparent decision-making processes and systemic investment in relational practice. Supporting these conditions may help reduce moral distress, improve staff retention and enhance patient safety by enabling ethical leadership to be consistently enacted in practice.Originality/value This study provides new empirical insight into the prerequisites associated with ethical leadership in health and social care. By reframing ethical leadership from an individual attribute to a systemic capability, the study highlights the individual, relational and organisational conditions associated with sustaining ethical practice in complex health and social care environments.
PURPOSE:The purpose of this study is to synthesis current literature and propose a hospital leadership structure that includes Advanced Practice Providers (APPs). Additionally, this study identified the need for formal leadership training for APPs like those that have been created for physicians which have shown to improve leadership skills, patient care and hospital performance. This study proposes a core foundational structure for leadership programs for APPs for hospitals to enact. DESIGN/METHODOLOGY/APPROACH:This study is a scoping review and narrative synthesis. Particular attention was paid to literature pertaining to APP leadership position creation as well as leadership development training programs. FINDINGS:APPs are essential in the delivery of quality patient care in hospital systems. With the increase in the number of APPs employed at hospital systems, there is a lack of opportunity for leadership positions or leadership training. A few hospital systems have reported departmental or hospital creation of leadership positions for APPs, which have found improvement in APP retention and job satisfaction. There needs to be a widespread and uniform transition in the leadership structure to include APPs. RESEARCH LIMITATIONS/IMPLICATIONS:Literature review relied on published literature and institutional reports, which may be subject to publication bias and variability in reporting quality. Additionally, much of the available literature was US-based, which may limit international generalizability. The available literature was limited by variability in study design, frequent reliance on single-institution reports and lack of outcome data limited comparative evaluation of leadership models. Few studies reported measurable leadership or patient outcomes, constraining comparative evaluation. The absence of standardized leadership metrics constrained formal quality appraisal. Additionally, APP-specific leadership literature remains relatively sparse, requiring selective inclusion of physician and nursing leadership studies to identify transferable models and competencies. ORIGINALITY/VALUE:This paper fills a gap of knowledge by identifying a lack of unity of leadership positions and lack of formal APP leadership training at the institutional level. Creation of APP leadership positions with formal leadership development training will improve APP job satisfaction, retention, quality of patient care and culture of the hospital system.
PURPOSE:This study aims to address the unresolved temporal puzzle in health-care leadership research by examining why adaptive leadership reliably activates early engagement yet fails to sustain or reverses its effects under prolonged exposure. DESIGN/METHODOLOGY/APPROACH:Using a three-wave longitudinal design (n = 451) across public health-care organisations, the study applies random intercept cross-lagged panel modelling to disentangle within-person dynamics from stable between-person differences. Time-ordered mediation and moderation pathways linking adaptive leadership, job resources, job demands, work engagement, workload intensity and commitment to service quality are estimated. FINDINGS:Adaptive leadership recalibrates across temporal phases, functioning as a phase-sensitive activation process an activation-oriented trigger that produces early gains in job resources and engagement. Over time, the same leadership behaviours generate cumulative job demands that erode engagement and suppress downstream service commitment. These effects exhibit pronounced lag asymmetries and non-monotonic trajectories, with workload intensity accelerating the shift from benefit-driven to cost-driven mechanisms. ORIGINALITY/VALUE:The study reconceptualises adaptive leadership effectiveness as temporally phase-dependent, identifying the temporal mis-fit between persistent activation-oriented behavioural repertoires and evolving consolidation demands as the proximate mechanism of declining effectiveness; extends job demands-resources theory into a longitudinal leadership process model; and establishes non-monotonic leadership effects as a systematic property of sustained health-care work systems rather than a boundary anomaly.
