First-Line Managers’ Experiences in Promoting Sustainable Leadership in Healthcare Organizations

Abstract Objectives First-line managers in healthcare play a pivotal role in shaping sustainable and resilient health systems, yet they often face high workloads, limited resources, and increasing administrative demands. These conditions affect not only their own well-being but also their ability to lead effectively and support healthcare teams. Strengthening conditions for leadership development and organizational support is essential to a resilient healthcare workforce and long-term system performance. This study aims to explore the prerequisites for sustainable leadership among first-line managers in healthcare. Methods Using an explorative qualitative design with an inductive approach, individual interviews were conducted with 25 first-line managers from various operational areas in southern Sweden between February and July 2024. The data were analysed through qualitative content analysis, identifying three themes and nine sub-themes. Results The findings reveal that sustainable leadership depends on three key areas: effective organizational structures, supportive collaborations, and innovative management skills. Managers emphasized the need for clearer role definitions, ongoing leadership training, and access to both administrative and collegial support. They also highlighted the importance of balancing autonomy with structured support to manage complexity, prevent burnout, and foster meaningful engagement. Conclusions Investing in the leadership capacity and well-being of first-line managers is essential to building sustainable health systems. Organizations must prioritize structured onboarding, continuous professional development, and collaborative cultures that empower managers. When healthcare leaders are supported and equipped to lead, they are better able to retain staff, promote positive work environments, and ultimately improve patient care. This study underscores that leadership is a managerial concern and a strategic investment in health system sustainability. Key messages • This study highlights the need for clear roles, support, and training to strengthen first-line managers’ leadership and well-being - key to resilient, sustainable healthcare systems. • Strong first-line managers create better work environments, reduce burnout, and contribute to a stable healthcare organization with higher quality and safer patient care.