Adaptive leadership in health crises: lessons from the COVID-19 pandemic for public health systems
DOI:
https://doi.org/10.56294/hl2025846Keywords:
adaptive leadership, systemic resilience, health crises, COVID-19, public healthAbstract
Introduction: The COVID-19 pandemic highlighted the rigidity of traditional leadership models in healthcare systems, underscoring the need for adaptive approaches to manage health crises. These models, based on fixed protocols, proved insufficient in dynamic environments with increasing demands, sparking interest in exploring adaptive leadership as an alternative. Objective: To analyze the role of adaptive leadership in the resilience of healthcare systems during health crises. Methodology: A scoping review was conducted of literature published between 2020 and 2025 in Scopus, Web of Science, and PAHO-IRIS. Thirty studies addressing the practical application of adaptive leadership in health crises were selected, with an emphasis on low- and middle-income countries. Qualitative analysis focused on geographic context, type of crisis, leadership strategies, and key findings. Results: Adaptive leadership proved crucial for systemic resilience, with competencies such as cognitive flexibility, strategic empathy, and innovation. Hybrid patterns combining hierarchy and collaboration were identified as effective in uncertain environments. Resource-limited settings stood out for disruptive solutions and a stronger emphasis on emotional intelligence. However, gaps in training and a lack of standardized indicators to assess adaptive competencies persist. Conclusions: Adaptive leadership is essential for managing health crises, but its implementation requires flexible frameworks and training focused on emotional and collaborative skills. Integrating these approaches into public health curricula and developing metrics to evaluate their impact on institutional resilience is recommended.
References
1. Wiesman J, Baker E. The Public Health Worker Mental Health Crisis—A Major Leadership Challenge. Journal of Public Health Management and Practice. 2022;28:95-98. https://doi.org/10.1097/PHH.0000000000001476
2. Praag L, DiasM, Farias S, Oliveira A, Vasconcelos M, Milicevic M, et al. Leadership in public health crisis: a review to summarize lessons learned from COVID-19 pandemic. The European Journal of Public Health. 2022;32(3):ckak129.544. https://doi.org/10.1093/eurpub/ckac129.544
3. Bhat Z, Bhat J, Saba N. Navigating the Storm: An Exquisite Leadership Insight into Healthcare Management amidst the COVID-19 Pandemic. Disaster Medicine and Public Health Preparedness. 2023;17:e484. https://doi.org/10.1017/dmp.2023.130
4. Rafila A, Blidaru T, Garofil D, Strilciuc Ș, Muresanu D. Addressing the Healthcare Crisis - The Bucharest High-level Regional Meeting on Health and Care Workforce in Europe: TIME TO ACT. Journal of Medicine and Life. 2023;16:963-966. https://doi.org/10.25122/jml-2023-1024
5. Bray J. Navigating the Crisis: Strategies for Addressing Healthcare Staffing Shortages. American Journal of Healthcare Strategy. 2024; 1(2):13-18. https://doi.org/10.61449/ajhcs.2024.3
6. Bracho Fuenmayor PL. Criminalización de la comunidad queer. Un estudio comparado con visión latinoamericana. Encuentros. Revista de Ciencias Humanas, Teoría Social y Pensamiento Crítico. 2023;18:226-241. https://doi.org/10.5281/zenodo.7901702
7. Poon Y, Lin Y, Griffiths P, Yong K, Seah B, Liaw S. A global overview of healthcare workers' turnover intention amid COVID-19 pandemic: a systematic review with future directions. Human Resources for Health. 2022;20:70. https://doi.org/10.1186/s12960-022-00764-7
8. Garrett J, McNolty L, Wolfe I, Lantos J. Our Next Pandemic Ethics Challenge? Allocating "Normal" Health Care Services. The Hastings Center Report. 2020;50(3):79-80. https://doi.org/10.1002/hast.1145
9. Ratcharak P. Leadership dynamics in health care crises: The impact of initiating structure and consideration behaviors on safety climate in public hospitals. Health Care Management Review. 2025;50:221-231. https://doi.org/10.1097/HMR.0000000000000444
10. Laur C, Agarwal P, Mukerji G, Goulbourne E, Baranek H, Pus L, et al. Building Health Services in a Rapidly Changing Landscape: Lessons in Adaptive Leadership and Pivots in a COVID-19 Remote Monitoring Program. Journal of Medical Internet Research. 2020;23(1):e25507. https://doi.org/10.2196/preprints.25507
11. Baker E, Irwin R, Matthews G. Thoughts on Adaptive Leadership in a Challenging Time. Journal of Public Health Management and Practice. 2020;26:378-379. https://doi.org/10.1097/phh.0000000000001179
12. Yeo R. In praise of COVID-19: discovering adaptive leadership in unprecedented times. Strategic HR Review. 2021; 20(3): 102-108. https://doi.org/10.1108/SHR-01-2021-0009
13. Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Annals of Internal Medicine. 2018;169(7):467-473. https://doi.org/10.7326/M18-0850
14. Sott MK, Bender MS. The Role of Adaptive Leadership in Times of Crisis: A Systematic Review and Conceptual Framework. Merits. 2025;5(1):2. https://doi.org/10.3390/merits5010002
15. Kuluski K, Reid RJ, Baker GR. Applying the principles of adaptive leadership to person-centred care for people with complex care needs: Considerations for care providers, patients, caregivers and organizations. Health Expectations: An International Journal of Public Participation in Health Care and Health Policy. 2021;24(2):175-181. https://doi.org/10.1111/hex.13174
16. Santra S, Alat P. Adaptive leadership of doctors during COVID-19. Leadership in Health Services (Bradford, England). 2021;ahead-of-print(ahead-of-print). https://doi.org/10.1108/LHS-08-2021-0073
17. Aouad M, Jalbout Hastie MJ, Yazbeck Karam V. Adaptive leadership in crisis: a healthcare system's resilience journey. BMJ Leader. 2025;9(2):89-93. https://doi.org/10.1136/leader-2023-000958
18. McKimm J, Ramani S, Forrest K, Bishop J, Findyartini A, Mills C, et al. Adaptive leadership during challenging times: Effective strategies for health professions educators: AMEE Guide No. 148. Medical Teacher. 2023;45(2):128-138. https://doi.org/10.1080/0142159X.2022.2057288
19. González-Mendoza JA, Riaño-Solano M, Sánchez-Molina J. Adaptive Leadership And Its Competencies For Times Of Crisis. Journal of Language and Linguistic Studies. 2022;18(2):1049-1061. https://www.jlls.org/index.php/jlls/article/view/4734
20. Matos RI, Cervero RM, Melton JL, Clemons MA, Sims BW, Ma T. Adaptive Leadership and Burnout in Military Healthcare Workers During a Global Health Pandemic. Military Medicine. 2024;189(Suppl 3):106-112. https://doi.org/10.1093/milmed/usae057
21. Bajaba A, Bajaba S, Algarni M, Basahal A, Basahel S. Adaptive Managers as Emerging Leaders During the COVID-19 Crisis. Frontiers in Psychology. 2021;12:661628. https://doi.org/10.3389/fpsyg.2021.661628
22. Garavaglia C, Sancino A, Trivellato B. Italian mayors and the management of COVID-19: adaptive leadership for organizing local governance. Eurasian Geography and Economics. 2020;62(1):76-92. https://doi.org/10.1080/15387216.2020.1845222
23. Sriharan A, Hertelendy AJ, Banaszak-Holl J, et al. Public Health and Health Sector Crisis Leadership During Pandemics: A Review of the Medical and Business Literature. Medical Care Research and Review. 2021;79(4):475-486. https://doi.org/10.1177/10775587211039201
24. Petropanagos A, Oliver J, Chidwick P. How adaptive leadership can enhance healthcare ethics. Healthcare Management Forum. 2025;38(4):290-294. https://doi.org/10.1177/08404704251327667
25. Fernandes V, Wong W, Noonan M. Developing adaptability and agility in leadership amidst the COVID-19 crisis: Experiences of early-career school principals. International Journal of Educational Management. 2023;37(2):483-506. https://doi.org/10.1108/IJEM-02-2022-0076
26. Pring ET, Malietzis G, Kendall SWH, Jenkins JT, Athanasiou T. Crisis management for surgical teams and their leaders, lessons from the COVID-19 pandemic; A structured approach to developing resilience or natural organisational responses. International Journal of Surgery (London, England). 2021;91:105987. https://doi.org/10.1016/j.ijsu.2021.105987
27. Smithson R. The compatibility of multiple leadership styles in responding to a complex crisis: leading a health service COVID-19 response. Journal of Health Organization and Management. 2021;ahead-of-print(ahead-of-print). https://doi.org/10.1108/JHOM-07-2021-0263
28. Nöthel S, Nübold A, Uitdewilligen S, Schepers J, Hülsheger U. Development and validation of the adaptive leadership behavior scale (ALBS). Frontiers in Psychology. 2023;14:1149371. https://doi.org/10.3389/fpsyg.2023.1149371
29. Sahu N, Sriram S, Samrat B, Choudhary AS, Amita Garg AG, Naregal PM. Assessing Healthcare Leadership Competencies in Crisis Management. Health Leadership and Quality of Life. 2024;3:371. https://doi.org/10.56294/hl2024.371
30. Singh PK, Singh S, Kumari V, Tiwari M. Navigating healthcare leadership: Theories, challenges, and practical insights for the future. Journal of Postgraduate Medicine. 2024;70(4):232-241. https://doi.org/10.4103/jpgm.jpgm_533_24
31. Carter J, Burke H. An Adaptive Healthcare Organization Can Effectively Respond to Medical Crises. International Journal of Public Health. 2023;68:1605581. https://doi.org/10.3389/ijph.2023.1605581
32. Alhayli MRS, Alhayli ARS, Alalawi MYA, Alalawi MMI, Alghubayshi AIA, Alghubayshi HIA, et al. Advancing resilience: Transformative roles of nursing leadership in shaping health administration. Power System Technology. 2024;48(4). https://powertechjournal.com/index.php/journal/article/view/999
33. Wu A, Preker A. Identifying international leadership competencies in medical education. Medical Science Educator. 2023;33:1405-1408. https://doi.org/10.1007/s40670-023-01897-7
34. Njuguna C, Tola H, Maina BN, Magambo KN, Namukose S, Kamau S, et al. Roles of health system leadership under emergency in drought-affected districts in northeast Uganda: A mixed-method study. BMJ Open. 2024;14:e080374. https://doi.org/10.1136/bmjopen-2023-080374
35. Ferrinho P, Lehman U, Kovács E, Dal Poz M. Relevant HRH leadership during public health emergencies. Human Resources for Health. 2022;20(28). https://doi.org/10.1186/s12960-022-00723-2
36. Wald HS. Optimizing resilience and wellbeing for healthcare professions trainees and healthcare professionals during public health crises – Practical tips for an ‘integrative resilience’ approach. Medical Teacher. 2020;42(7):744-755. https://doi.org/10.1080/0142159X.2020.1768230
37. Bookey-Bassett S, Rose D, Purdy N, et al. Multidisciplinary First-Line Healthcare Leaders’ Roles and Experiences During the COVID-19 Pandemic in Ontario Canada. Canadian Journal of Nursing Research. 2024;56(3):269-280. https://doi.org/10.1177/08445621241236665
38. Evans J, Grudniewicz A, Yang M, Gutberg J, Singer S. The role of leaders in shifting to virtual primary care delivery during the COVID-19 pandemic in Ontario's CHCs. The Annals of Family Medicine. 2023;21(1):3624. https://doi.org/10.1370/afm.21.s1.3624
39. Karreinen S, Paananen H, Kihlström L, Janhonen K, Huhtakangas M, Viita-aho M, et al. Living through uncertainty: A qualitative study on leadership and resilience in primary healthcare during COVID-19. BMC Health Services Research. 2023;23:233. https://doi.org/10.1186/s12913-023-09223-y
40. Smallwood N, Bismark M, Willis K. Burn-out in the health workforce during the COVID-19 pandemic: Opportunities for workplace and leadership approaches to improve well-being. BMJ Leader. 2023;7:178-181. https://doi.org/10.1136/leader-2022-000687
41. Crain MA, Bush AL, Hayanga H, Boyle A, Unger M, Ellison M, et al. Healthcare leadership in the COVID-19 pandemic: From innovative preparation to evolutionary transformation. Journal of Healthcare Leadership. 2021;13:199-207. https://doi.org/10.2147/JHL.S319829
42. Schlinkert C, Muns L, van Tuyl L, Wagner C. How well prepared are hospitals for future crises? Board members perceive their hospitals as resilient for acute crises. BMC Health Services Research. 2024;24(817). https://doi.org/10.1186/s12913-024-11197-4
43. Nzinga J, Boga M, Kagwanja N, Waithaka D, Barasa E, Tsofa B, et al. An innovative leadership development initiative to support building everyday resilience in health systems. Health Policy and Planning. 2021;36(7):1023-1035. https://doi.org/10.1093/heapol/czab056
44. Angeler D, Eyre H, Berk M, Allen C, Hynes W, Linkov I. Adaptation, Transformation and Resilience in Healthcare. International Journal of Health Policy and Management. 2022;11:1949-1952. https://doi.org/10.34172/ijhpm.2022.7043
45. Ali H, Ranse J, Roiko A, Desha C. Developing a Healthcare Transformational Leadership Competency Framework for Disaster Resilience and Risk Management. International Journal of Disaster Risk Reduction. 2024; 113(15):104898. https://doi.org/10.1016/j.ijdrr.2024.104898
46. Finstad G, Giorgi G, Lulli L, Pandolfi C, Foti G, León-Pérez J, et al. Resilience, Coping Strategies and Posttraumatic Growth in the Workplace Following COVID-19: A Narrative Review on the Positive Aspects of Trauma. International Journal of Environmental Research and Public Health. 2021;18(18):9453. https://doi.org/10.3390/ijerph18189453
47. Hertelendy A, Chekijian S, McNulty E, Mitchell C, Grimes J, Durneva P, et al. Crisis leadership: a case for inclusion in accredited Master of Public Health program curricula. Public Health. 2022;209:14-18. https://doi.org/10.1016/j.puhe.2022.05.012
48. Cai W, Gao R, Jing Q, Wang C, Hou N, Liu W, et al. Doctor of Public Health-Crisis Management and COVID-19 Prevention and Control: A Case Study in China. Frontiers in Public Health. 2022;10:814632. https://doi.org/10.3389/fpubh.2022.814632
49. Hollis J, Kocanda L, Seward K, Collins C, Tully B, Hunter M, et al. The impact of Healthy Conversation Skills training on health professionals' barriers to having behaviour change conversations: a pre-post survey using the Theoretical Domains Framework. BMC Health Services Research. 2021;21:880. https://doi.org/10.1186/s12913-021-06893-4
50. Bradley E. Diversity, Inclusive Leadership, and Health Outcomes. International Journal of Health Policy and Management. 2020;9:266-268. https://doi.org/10.15171/ijhpm.2020.12
51. Bracho-Fuenmayor PL. Estado fallido. Un análisis desde la perspectiva de Rotberg. Encuentros. Revista de Ciencias Humanas, Teoría Social y Pensamiento Crítico. 2025;23:228-244. https://doi.org/10.5281/zenodo.14268859
52. Fontes-Filho J, Kaufmann C, Fonseca T, Pimenta R, Souza J, Novaes E. Governance of interorganizational health emergency networks: Facing the Zika pandemic. Annals of Public and Cooperative Economics. 2020; 92(2):333-354. https://doi.org/10.1111/apce.12299
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