To explore how contextual factors affect the practice of learning-oriented leadership in fragmented healthcare systems.
A qualitative case study using a participatory approach. Data were collected through semi-structured focus groups and interviews with leaders across hospital levels. Thematic analysis was applied.
Four contextual factors were identified: (1) multiple external drivers (why), (2) diverse actors and perspectives (who), (3) emergent, unpredictable change (how) and (4) organizational resources and support (what). The study refines the learning-oriented leadership framework in fragmented healthcare systems by emphasizing (1) cross-boundary leadership, (2) contradiction management, (3) leading for organizational learning under resource constraints and (4) differentiated leadership roles across levels.
By integrating empirical insights with expansive learning theory, the study advances the learning-oriented leadership framework and offers strategies for leadership and policy in complex healthcare systems.
