Complexity science in health and social care leadership research: a scoping review secondary analysis

In the ever-evolving landscape of healthcare, leadership has emerged as a pivotal force in driving the adaptation and effectiveness of complex health and care systems. Leadership plays a crucial role in health and social care, as it influences the delivery of safe and effective care to individuals (Rogers, 2012), as well as promoting the health and well-being of organisational staff (Brand et al., 2017). Internationally, health and social care systems are increasingly under pressure to navigate and resolve historical and emerging challenges that inhibit clinical care and place demands on professionals. Health and social care systems are increasingly considered complex adaptive systems (Glover et al., 2020; Pype et al., 2017), with each individual setting containing its own complexities, nuances and challenges. Some of the factors that leaders must engage with and respond to within modern health and social care systems include resource limitations and advancements in clinical practice (Underwood, 2024). By acknowledging the complexity of interactions between patients, staff and external factors, such as international and local policies and technological advancements, leaders have the potential to develop more holistic and effective solutions to address challenges within the landscape of modern healthcare systems. While leadership has been referred to and defined in various ways, in the context of the current review, leadership refers to “a process whereby an individual influences a group of individuals to achieve a common goal” (Northouse, 2025, p.6). Leadership is entangled with the context in which it is enacted, shaped by social constructs within a particular environment, evolving over time and influenced by historical factors. Leadership transcends the traditional notion of hierarchical influence from superiors to subordinates (Farahnak et al., 2020); rather, it primarily embodies the collective influence exerted by individuals both within and outside the system.

The lens of complexity science has been adopted to address the complex issues we face as a society, including the provision of health and social care. However, academic commentators have critiqued the current application of complexity theory to empirical research on health and care as lacking rigour and engagement with its core principles (Greenhalgh and Papoutsi, 2018). The authors’ recent scoping review underlined the huge divergence and lack of transparency in its application in health and social care research (Carroll et al., 2023). More specifically, complexity science offers a novel framework for understanding leadership in complex adaptive systems, emphasising the importance of adaptability, collaboration and emergent behaviours. Leadership is critical within complex adaptive systems in making judgments that lead to action at different scales of responsibility and operations and resolving challenges at individual and organisational levels (Comfort and Resodihardjo, 2013). The process and execution of leadership in health and social care settings are particularly important for ensuring the effectiveness and quality of care to the people health systems seek to treat, as well as the provision of integrated care (Sfantou et al., 2017).

For the current study, the authors conducted a secondary analysis of a scoping review of the application of complexity science in health and social care research (Carroll et al., 2023). Secondary analysis involves revisiting pre-existing data collected for a specific area of interest, allowing for a more targeted examination of the data. The purpose of the initial review was to explore in what ways complexity science has been employed in research pertaining to health and social care. A goal of the original review was to map the broad definitions of complexity science used, how complexity science was used and the outcomes of its application. The authors found that complexity theories were inadequately defined and described when applied in health and social care research, with its most common application as a theoretical and analytical framework. Despite this lack of methodological rigour, the authors identified that a deeper investigation of articles that dealt with the concept of leadership – a seminal concept that is heralded for its potential to inspire and implement solutions to challenges in health and social care systems (Barr and Dowding, 2022) was required. This secondary analysis seeks to build on Belrhiti et al. (2018) scoping review regarding complex leadership in health care. While this review provided comprehensive insight into how complexity science has been applied to leadership in health care, it did not include social care systems in its strategy. In addition, some time has passed since Belrhiti and colleagues’ original publication in 2018, their search strategy was defined as between the years 2000–2016. The findings of this secondary analysis may facilitate a comprehensive understanding of how leadership is enacted within complex systems and inform evidence-informed strategies for leaders to navigate the nuances and challenges of health and social care settings. The objectives of the secondary analysis were:

• To examine the phenomenon of leadership within health and social care contexts in which complexity science was applied.

• To understand the intention of applying complexity science to understand the concept of leadership.

• To identify the outcomes of applying complexity science in leadership in health and social care.

• To recommend how complexity science can be applied in future health and social care leadership research.

The original review protocol (Carroll et al., 2021) and original scoping review (Carroll et al., 2023) were peer-reviewed and published previously. A brief overview of the scoping review methods employed is presented here which adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist criteria (Tricco et al., 2018), specific to the secondary analysis aims. The scoping review adhered to the framework for scoping reviews developed by Arksey and O'Malley (2005) and subsequent refinements made by succeeding authors. The research question for the larger scoping review was:

Keywords and controlled vocabulary terms were developed and identified, in collaboration with a university librarian, using the PCC Framework: population (health and social care professionals), concept (application of complexity science) and context (health and social care settings). The full search strategy is available in Supplemental File 1. Custom searches were conducted in Cochrane Database of Systematic Reviews, MEDLINE, CINAHL, EMBASE, Web of Science, PSYCHINFO, The NHS Economic Evaluation Database (NHS EED), The Health Economic Evaluations Database (HEED). In addition, a manual hand-search of the reference lists of relevant articles was conducted for comprehensiveness.

Citations and abstracts from the searches were maintained in Covidence, a web-based review management system. The scoping review inclusion criteria considered qualitative and quantitative primary research utilising complexity-informed approaches in health and social care settings, published in the English language between the years 2012 and 2021. Publications were excluded from the review if they were retrospective reviews, secondary research, conference abstracts, book reviews, commentaries or editorial articles, opinion papers, letters and non-English articles. Data extraction was conducted on the included articles using the Covidence software, according to the review research question e.g. methodological approach, definition/description of complexity science and/or specific complexity theories used and key findings/impact of the research. A total of 2021 articles were initially identified. Following duplicate removal, 1,345 articles were screened and 1,108 did not reach the inclusion criteria. The remaining 237 articles were full-text screened by the author team, which led to the identification of 61 final articles, as seen in Figure 1.

Adhering to standard scoping review practice, no quality appraisal was conducted, as the aim was to map, not to critically appraise, the available evidence. Following guidance by Levac and colleagues (Levac et al., 2010) to go beyond the available literature and consult relevant stakeholders when undertaking a scoping review, the authors engaged several individuals with lived experience of health and social care (i.e. patients, health and social care professionals, policymakers and researchers). The focus of these consultations was to identify the priorities and gaps in knowledge regarding health and social care that guided the research question in the review. Consultations with researchers were conducted by a leading author (AC) on an individual basis through in-person conversation or email exchanges. Notes were recorded during these consultations and analysed to capture the key priorities that could be addressed in the scoping review. Findings from the scoping review were shared and discussed with individuals who took part in the initial consultation exercise. An established hospital patient forum, which serves as a platform for dialogue and the exchange of hospital-related information among patients and health and social care professionals, was involved in both the design and interpretation of the scoping review findings to ensure their relevance and applicability from a patient and health and social care perspective. The author team invited individuals unfamiliar with research practices or the field of complexity to an information session before participating in the forum. Individuals were provided with accessible written materials to inform and equip them before taking part in the consultation.

Guidance regarding the process for secondary analyses of scoping reviews is limited; however, scholars in library science have indicated that the analytic process involves developing the research question(s), identifying the data set to be investigated and completing a thorough evaluation of relevant data (Johnston, 2014).

For this secondary analysis, the authors reviewed all 61 full-text articles included in the initial scoping review for inclusion and analysis. The authors sought to address the question:

The authors included articles in the secondary analysis that explicitly investigated leadership using a complexity lens as their primary empirical aim. All articles were reviewed by two members of the author team to determine whether the phenomenon of leadership was explored in the study. To avoid potential terminological confusion, it must be acknowledged that the focus of the review was not to identify studies that utilised complexity leadership theory, rather how complexity science has been applied to the concept of leadership in health and social care settings.

After determining the relevant articles that met the secondary analysis inclusion criteria, as seen in the PRISMA Flowchart in Figure 2, the authors extracted data from each article based on the review question, i.e. intention of complexity science application regarding leadership, contexts of leadership and outcomes of application.

A total of nine articles were identified in the secondary analysis. The key characteristics of the included studies are detailed in Table 1.

Of these nine articles, three were conducted in the United States of America, four were conducted in Canada and one article was identified in Serbia and the United Kingdom, respectively.

Three studies focused on leadership in nursing care settings. Bungay and colleagues’ study (Bungay and Stevenson, 2013) was situated within a sexual health nursing practice during a period of regulatory policy changes that expanded advanced practice roles and acute care settings. The authors undertook the study to specifically understand the experiences of nurse leaders who implemented the change at an organisational level. Similarly, McKinney and colleagues’ study (2016) focused on directors of nursing leadership style impacted care quality outcomes within a nursing home setting. The most recent study conducted within the field of nursing investigated nurse supervisory support practices as a form of leadership and its impact on system behaviour within a long-term care clinical environments (Escrig-Pinol et al., 2019).

Lindberg and Schneider’s (2013) case study looked at organisational change processes regarding healthcare setting-associated infections within two organisations i.e. a community hospital and a tertiary care centre. Similarly, Gordon and colleagues (2016) situated their research in two health and social care organisations (i.e. a general practitioner practice serving a town and a rural district, and an older person rehabilitation ward within a hospital ward) to explore how interprofessional healthcare teams enacted leadership at a micro-level. McKechnie and colleagues (2020) specifically examined parents’ experiences within a paediatric health service. The context of two studies were in more broad terms; Grady’s (2016) study looked at physician leadership development in health care organisations and Horvat and Filipovic’s (2018) study examined health leaders views on improving quality and maturity within a health system that included secondary and tertiary health care services. Tsasis and colleagues’ (2012) research was the only article which focused on the field of integrated care. This qualitative study examined how integrated care delivery were being developed and established within in a large region based in Canada, based on the experiences of healthcare professionals and managers in the region.

The identified studies showed a diversity in how complexity science was applied in their respective contexts. The studies varied in methodology, including six qualitative and two quantitative studies, as well as one case study report. The method in which researchers applied complexity science principles to the concept of leadership was heterogeneous. Eight of the nine articles used complexity science as a theoretical framework to understand their phenomena of interest, while five of these studies used it further as a method of data analysis. The level of detail in which complexity science varied within the articles. For example, Grady (2016) used five principles of complexity science (connectivity, interdependence, feedback, exploration of the space of possibilities and coevolution) as a framework for interviewing health leaders and for a document review process. Tsasis and colleagues (2012) used the most commonly cited characteristics of complex adaptive systems, identified in an earlier evidence synthesis and concept analysis (Wallis, 2008), as their framework for analysing qualitative data. Lindberg and Schneider’s (2013) case study (Lindberg and Schneider, 2013), focused on the aspect of positive deviance in their investigation of how leaders tackle healthcare setting-related infections. One study specifically focused on complexity leadership theory in health care organisations (Lindberg and Schneider, 2013), whereas another study based their research on the Heifetz Adaptive Leadership Framework which considers individuals as complex adaptive systems, whereby people engage in process of adaptive work that supports them to physically and psychologically adapt to their context, in their study of parental caregivers (McKechnie et al., 2020). Other studies, broadly spoke of how complexity science was utilised and did not specify particular aspects of complexity theory that were applied in the research (Escrig-Pinol et al., 2019; Gordon et al., 2017; McKinney et al., 2016).

While there were varying contexts and approaches in using complexity science, the recurrent outcome of the identified evidence were the lived experiences of leaders during a time of implementing or navigating change. Grady (2016) concluded that a physician’s relationship with their patient and their potential for innovation can act as catalytic behaviours within complex systems. Their findings also identified limiting factors that inhibit physicians who choose to lead, such as reimbursement models that do not place value on leadership and medical education that provides minimal opportunity for leadership skill development. Gordon et al. (2017) found that video-reflexive ethnography allowed leaders to see and reflect and adapt their leadership in practice. In a study of the impact of nurse supervisory relationships with care teams, the authors found that these relationships impacted on the quality of care provided to patients and the environment they worked. A seminal finding of this study is the value of interdependence of roles amongst supervisors and team members. This awareness facilitated collaborative and supportive relationships, as well as effective communication. Conversely, the authors found that the leading diminishing factor on relationships within occurred when roles were rigid and inflexible (Escrig-Pinol et al., 2019). Adopting the lens of complexity enabled the authors to identify how supervisory relationships were at their most effective and productive when supervisors could continually adapt their management style to the needs of their colleagues and the environment in which they worked.

Although McKinney and colleagues’ (McKinney et al., 2016, p. 231) state “alternative complexity leadership behaviours that increase connections and interactions between individuals will increase identification of emerging health status changes and creative solutions to clinical problems”, they utilise the Bonoma/Slevin leadership model which is not specific for complexity leadership. One category within the model is consensus manager, which the authors seem to equate with complexity leadership. Their results report that 34% of directors of nursing scored as consensus managers and suggest that consensus leaders show high degrees of complexity leadership by continuously seeking information and encouraging shared decision-making which resulted in better care outcomes. Bungay and colleagues’ (2013) study highlighted how nurse leader engagement was critical in effective policy implementation and acknowledged that the multiplicity of roles and responsibilities of public health nurses were barriers to effective implementation. McKechnie and colleagues’ (2020) study showed how parents of children with a life-threatening condition demonstrated non-linear development towards adaptive work and leadership as they navigated intra and interpersonal domains. In their survey study, Horvat and Filipovic (2018) indicated that administrative leadership had no significant influence on the maturity of health care organisations whereas adaptive and enabling leadership had significant influences on some types of maturity. Lindberg and Schneider’s (2013) case study of an MRSA collaborative revealed how complexity-informed conscious leadership, understanding the social and human aspects of organisational leadership, can shape self-organisation in a manner that facilitates creative, productive, desirable outcomes. The authors further found the influential and interrelated roles of anxiety, attachment and relationships in facilitating effective organisational leadership.

Using a complex adaptive systems approach, one study identified several barriers to establishing integrated care networks and system integration including ineffective alignment amongst professionals and their organisations, inherent system complexity, a lack of funding for and focus on collaboration and hierarchical “command and control” management styles (Tsasis et al., 2012, p. 7). The authors concluded that by engaging in complexity science, it enabled them to understand that the poor integration of health and social care services was potentially a result of historically viewing the system in a linear and reductionist manner, rather than as a complex adaptive system. The authors describe the value of framing the integration of health systems as an ever-evolving and dynamic learning process instead of an input-process-output methodology, which is particularly important for leaders when implementing new initiatives or change processes.

The aim of this secondary analysis was to provide a deeper insight into how complexity science has been applied in the context of leadership in health and social care settings. Building on the findings of the original review (Carroll et al., 2023), this review offers a holistic understanding of how leadership has been engaged with using the lens of complexity science. Despite the growing popularity of complexity science in organisational and economic research (Rosenhead et al., 2019; Tourish, 2019), efforts to apply it within health and social care organisations, particularly related to leadership, are still in their infancy, which echoes a recent review on the topic of integrated care and leadership more broadly (Mitterlechner, 2020). The use of complexity science led to the identification of nuanced findings regarding health and social care settings. For example, the results of McKinney and colleagues’ study supported how nurse leaders who embrace complexity leadership approaches led to better care outcomes for nursing home residents. Leadership behaviours included interacting freely with staff members, discussing resident issues and undertaking shared decision-making processes. In addition, Grady’s findings (Grady, 2016) indicate that by being a physician, leadership is assumed in their role, however, their capacity to lead in their organisation cannot be assumed.

Acknowledging the limited number of studies that were identified in this secondary analysis, our findings indicate that complexity science has yet to be applied rigorously and at a scale at would allow us to determine trends in its impact or real potential. For example, while the review sought to expand on Belrhiti and colleagues’ (2018) review by including social care, only one study in the field of social work (Tsasis et al., 2012) was found, focusing on integrating health and social care provision. However, this finding may echo the broader challenges social care faces in conducting practitioner research, such as constraints in research capability and organisational resources (Lunt and Shaw, 2017). While empirical research is acknowledged as a vital component in shaping the knowledge base and practice of social care and social work (Pulman and Fenge, 2023), if practitioners are not supported in their research capacity, it may be challenging to undertake research regarding their leadership or maintain a research culture in which external researchers investigate their contexts.

From a methodological perspective, most studies used complexity science as the underlying theoretical framework for their research on leadership. Complexity science was applied for a number of reasons including implementing policy and organisational change (Bungay and Stevenson, 2013; Lindberg and Schneider, 2013), leadership development skills and understanding specific organisational contexts (Gordon et al., 2017; Horvat and Filipovic, 2018). Similarly, the majority of studies provided insights into or explanations of their specific health and social care phenomenon, with only one offering practical tools for physician leadership development (Grady, 2016).

Given that complexity has been valued for its contribution to leadership practice and research (Wallis, 2008), the limited number of studies raises questions about healthcare professionals’ awareness and knowledge of and attitudes towards complexity science. The inclusion of awareness, education or training regarding complexity may be beneficial within health and social care management curricula. If professionals are entering into a complex adaptive system, they may benefit from having the appropriate knowledge to understand the context with this lens. We are conscious that complexity science is but one approach that can be used to understand health and social care settings; however, it may be an important tool to equip health and social care professionals and leaders with a more robust evidence base, as highlighted by our findings.

It must be noted that only one identified study focused on leadership within an integrated care setting. In contrast, the other articles focused on one particular health or social care setting or phenomenon. Integrated care, which is known to be difficult to define, broadly refers to a holistic approach to healthcare that aims to improve patient outcomes and experiences by coordinating and integrating the delivery of health and social services. Recently, the World Health Organisation (2015) called for innovation to improve services and a strong emphasis on integrated care, by reorienting health systems towards a collaborative primary care approach with team-based care. Several challenges and barriers exist to the realisation and implementation of integrated care internationally (Bamber and Marshall, 2023). To facilitate the shift towards integrated care in our global healthcare settings, as with any change, it requires leadership that can inspire and implement appropriate, effective measures. Acknowledging how Tsasis and colleagues (2012) posited that integration of health and social care services should be studied using a complex adaptive systems perspective as an anchor, the current secondary analysis underlines the lack of research undertaken regarding integrated care using complexity science.

Leadership is valued as a critical approach to inspire and drive new changes within integrated care contexts (Nieuwboer et al., 2019; Bamber and Marshall, 2023; Duncan, 2019). Nieuwboer and colleagues (2019) observed that leadership is key component of providing effective integrated care in a primary care context, with leaders’ relational and organisational skills and process and change management being critical to service integration. Conversely, Thomson and Chatterjee (2024) underlined that leadership can be an active barrier to the delivery of integrated care, as it has been applied sparingly despite empirical recommendations. The authors also found that leadership is important to navigate the issues of power and influence that can arise in establishing integrated care such as professional hierarchies, biases and implicit tensions within the care setting (Thomson and Chatterjee, 2024). However, leadership has been referred to as the “neglected topic” within the field of integrated care (Amelung et al., 2021), despite being identified as a central component of its delivery in this complex environment (Kirst et al., 2017). In their recent review on the role of leadership in supporting integrated care networks, Mitterlechner (2020) argued that the field of leadership and integrated care could benefit from expanding the theoretical frameworks which have been used to understand it – making specific reference to complexity leadership theory, a leading complexity science theoretical framework. Therefore, it is important to get a deeper understanding of how complexity science, a framework valued for its ability to interpret inter-organisation and interdisciplinary care, which is at the heart of integrated care (Lennox-Chhugani, 2023).

Health and social care systems are extremely complex with multiple organisations structures, care pathways, financial models, cultures, professional groups and legal responsibilities. Traditional leadership models often struggle to address the complexities and unpredictability inherent in healthcare settings (Elliott et al., 2020). Complexity science may provide a valuable framework for understanding the dynamics and behaviour of healthcare systems, particularly in the context of integrated care (Joseph-Richard and McCray, 2023; Carroll et al., 2023). Leaders in health and social care must acknowledge the interconnected, non-linear relationships within their respective systems. If we are to understand and engage with health and social care settings as complex adaptive systems, as the evidence points us towards (Joseph-Richard and McCray, 2023; Rosen et al., 2018), so too should the leaders in these settings be understood through this lens.

There was an evident lack of innovative use of complexity science in the creation of health and social care solutions, which merits future research and development. Complexity science emphasises the importance of fostering a culture of collaboration and experimentation. Leaders should create an environment where innovative ideas are encouraged, and experimentation is perceived as a valuable learning opportunity. This approach can lead to the discovery of novel solutions to complex problems in health and social care. As health and social care systems are increasingly encouraged to provide integrated care, implementing this in practice poses many barriers and challenges to how they fundamentally operate. Therefore, it is crucial that complexity science be utilised to develop innovative ways in supporting the shift towards integrated care and service integration, rather than being retrospectively applied to examine the facilitators and barriers of this change.

Recognising team culture and the leadership style influence the way experiences contribute to the functioning of a team (Rosenhead et al., 2019; Martin, 2018), such innovations could be leadership development programmes or accessible educational tools for organisational teams, founded on complexity, that highlights to all staff members the complex dynamics within their setting and the role they play within an ever-evolving care environment. Recognising health and social care organisations as complex adaptive systems and applying complexity science in research and clinical practice may promote the development of adaptive and dynamic leadership skills. These skills may empower individuals to respond to the inevitable challenges and changes in their interactive, ever-changing contexts. If health and social care leaders do not embrace and embed complexity, health and social care practice and research may be destined to repeat the same patterns and shortcomings of our health and social care systems that we have seen and experienced to date.

The lens of complexity science offers a new approach to understand and develop leadership approaches; pivoting the perspective of leadership away from traditional hierarchical “managerial implementers of top-down directives” (Rosen et al., 2018p. 109) to a collaborative process between individuals within health and social care organisations that focuses on the explicit and implicit relationships, patterns and behaviours (Uhl-Bien et al., 2020). There is potential for complexity science to be included in health and social care leadership research, particularly in areas where its application may benefit are improvement in clinical practice, change processes and implementation. It must be noted that the phenomenon of leadership emerged as a finding or was mentioned in the article discussions in the majority of studies excluded, as it was not a primary empirical aim, as seen in Figure 2. For example, leadership emerged as a key finding in studies regarding the development of a digital dashboard (Uhl-Bien et al., 2020) and primary health care pathway for intimate partner violence (Gremyr et al., 2019) but leadership was not a primary study aim from the outset. This observation not only highlights the fundamental and underlying role of leadership within complexity-informed health and social care research but signals the need to increase efforts that specifically investigate it.

Acknowledging the limited number of studies that were identified in the secondary scoping review, further research is essential which explores how complexity science can inform leadership practices in healthcare organisations, enabling leaders to navigate uncertainty, promote innovation and foster resilience, which is central to the pillars and provision of integrated care services (Gear et al., 2018). Echoing the guidance for complexity in health and social care research (Carroll et al., 2023), the findings of the secondary analysis signal the need for transparency and rigour in leadership-specific complexity research. A number of key facets in future research would facilitate this. Researchers should provide a clear definition of leadership and provide a detailed account of the leadership context, including the leadership style and professionals involved in the setting. It may also be beneficial to include an explicit description of the leadership framework, model or theory employed in the setting, where relevant. The articles in the current review presented little evidence before and after the application of complexity science. As complexity science is increasingly being applied in health and social care research (Carroll et al., 2023), researchers should explicitly describe the aspect of leadership they are examining using complexity and the outcomes or impact of adopting a complexity-informed approach, where relevant. It would be valuable for researchers to provide insight into the key contextual issues of the health and social care setting within which the leaders operate, including relevant historical factors and how the environment has evolved. This is particularly important given the heterogeneity of models and resources of care services internationally.

Acknowledging that the current secondary analysis covers evidence up to 2021, the authors observe that there have been many discussion articles since arguing for its use in health care or retrospectively applying complexity science to previous research (Borghmans and Laletas, 2023; Khalil and Lakhani, 2021; Wright, 2024). However, there appears to be a lack of momentum in conducting primary research using the lens of complexity. We believe that the application of complexity science within primary empirical research regarding leadership may support the identification of ways to implement or increase the awareness of complexity within health and social care leadership and wider organisational management. Acknowledging that effective leadership within complex adaptive systems requires leaders to be adaptable and respond to the interactive context (Underwood, 2024), empirical research using complexity science can facilitate the understanding of the context and ways in which the leadership is being enacted and can expand their role as collaborators in the environment to improve the adaptability and rigour of the system (Rosen et al., 2018). Complexity science may be a key theoretical underpinning of future leadership training interventions in developing integrated care leaders, as their scarcity has been recently observed (Thomson and Chatterjee, 2024), and echoes Mitterlechner’s (2020) recommendation of broadening the theoretical palette used within the field of leadership and integrated care.

While the authors conducted a rigorous secondary analysis of a previously published scoping review, some limitations must be acknowledged. The original scoping review conducted comprehensive and systematic searches using key terms regarding the application of complexity science in health and social care research, which encompassed health and social care leaders. However, the original search strategy did not specifically include terms to search for all types of leaders in these contexts, whereby some articles may not have been identified. The authors note that health and social care educational settings were excluded in the search strategy. This criterion means that the current analysis did not include research regarding the application of complexity science within leadership education in health and social care settings, which warrants future evidence synthesis. The small number of studies in the secondary analysis limits the generalisability of the findings. However, the current findings offer opportunities and guidance on conducting research using the lens of complexity science to understand the phenomenon of leadership in health and social care contexts.

This secondary analysis of a scoping review highlights the limited application of complexity in the practice of leadership in health and social care settings. Complexity science offers valuable insights for reimagining healthcare leadership in an increasingly complex and dynamic environment. The review signals a need to embrace complexity theory, with the aim of addressing the complex demands and system constraints we face today, particularly in the shift towards integrated care systems. By engaging with the principles of complexity science, health and social care leaders may nurture adaptive, resilient and innovative leadership practices that drive organisational excellence and promote positive outcomes for patients, staff and other key stakeholders. Adopting a complexity-informed approach to health and social care leadership has the potential to transform the way leaders navigate challenges, inspire change and shape the future of health and social care delivery and integration.

The supplementary material for this article can be found online.