Adaptive leadership in health crises: lessons from the COVID-19 pandemic for public health systems

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.