Working Apart Together: Relational Leadership, Role Attribution and Power Dynamics in Hospital Crisis Management During COVID-19

Objectives: This study examined how relational leadership and role attribution were perceived by key professionals (eg, physicians, nurses, managers, board members) in the crisis management teams of one academic medical centre. Furthermore, the authors explored the role of hierarchy and power dynamics when crisis management took over responsibility. Design: The research design was qualitative—interpretive with the use of Relational Leadership Theory. They followed an abductive and iterative research approach using observations, document analysis and semi-structured interviews as main methods. Results: Physicians occupied all key leadership roles in the crisis management structure, with their suitability for these positions unquestioned. Role attribution was shaped by formal expertise and informal networks, based on long-standing relational ties. Within the physicians’ group, perceptions of each other’s leadership abilities varied, with specific crisis competencies linked to individual traits. Despite the hierarchical, command-and-control presentation, much of the work occurred through emergent deliberative processes and informal networks. Power dynamics were continuously negotiated between professional groups, revealing tensions between hierarchical authority and collaborative crisis management. Conclusions: Drawing on healthcare professionals’ experiences during the COVID-19 pandemic, this study demonstrates that effective crisis management extends beyond formal training and established hierarchies. Their findings show how relational leadership practices and power dynamics shape collective crisis responses, highlighting the importance of adaptive, relational leadership for strengthening organisational resilience and responsiveness.