Harnessing leadership experiences for improved healthcare delivery: A scoping review of the experiences of healthcare leaders in navigating crisis

BACKGROUND: The COVID-19 pandemic placed unprecedented strain on health care systems worldwide, exposing and amplifying longstanding vulnerabilities in leadership and management structures. Although the roles of frontline healthcare workers have been widely documented, the experiences of healthcare leaders remain understudied. OBJECTIVE: To systematically synthesize global evidence on healthcare leaders’ experiences in navigating crises, with a particular focus on the pandemic; and to derive actionable strategies to strengthen crisis preparedness, response capacity, and health system resilience. DESIGN: A scoping review was conducted following Arksey and O’Malley’s framework. The reporting of the review adhered to the recommendations outlined in the PRISMA-ScR checklist. METHODS: Peer-reviewed articles published in English from 2020 to 2026 that reported on the experiences of healthcare leaders were included. Gray literature, review articles, and studies that did not explicitly focus on managerial experiences were excluded. Databases including EMBASE, Emcare, CINAHL, MEDLINE (Ovid), PsycINFO, Scopus and Web of Science were searched. A total of 20,107 records were identified, of which 10,203 were screened after deduplication. After full-text review, 277 articles were extracted for analysis. Data extraction followed a structured approach, capturing study characteristics, healthcare settings, and key findings. Thematic analysis was conducted using Delve software, with systematic coding applied to ensure analytical rigor. RESULTS: Three interrelated themes with 16 sub-themes emerged: (1) navigating leadership challenges during crisis, (2) leadership strategies and adaptive responses, and (3) implications for future crisis leadership and resilient health systems. The findings illuminate how adaptive leadership, judicious resource allocation, transparent communication, digital transformation, and attention to workforce mental health function as critical mechanisms for navigating complex health crises. CONCLUSIONS: This study demonstrates that effective healthcare crisis leadership extends beyond operational competence to require adaptability, clear communication, and sustained commitment to workforce well-being. Strengthening leadership capacity, investing in interoperable digital infrastructure, and embedding mental health supports within crisis preparedness frameworks will be critical to enhancing health system responsiveness and sustaining resilient care delivery during future global disruptions. SOCIAL MEDIA ABSTRACT: Healthcare leaders showed great adaptability during COVID-19, but lasting system resilience requires more than individual effort. It demands investment in equitable, well-resourced systems, ethical leadership, integrated digital infrastructure, and cultures that support leader and staff well-being. [A scoping review | @SABoamah].