Leadership as relational practice: The interplay of role attribution in a hospital context during COVID-19

Purpose: The aim of this paper is to explore how business managers in an academic medical centre experienced and talked about their work and leadership practices during the COVID-19 crisis, with particular attention to relational practices and role attribution. Design/methodology/approach: We conducted a qualitative–interpretive study in a Dutch university hospital, drawing on at-home ethnography, in-depth interviewing, elicitation techniques, and member check focus groups. Findings: When business managers describe leadership in general, they tend to draw on the language of skills and competencies. Yet, when reflecting on their own crisis practices, they foreground relational practices and emphasize how colleagues and senior leaders attributed leadership to them. Three themes stand out: (1) crises magnify existing organizational strengths and weaknesses; (2) listening, shielding, and supporting team members become central practices; and (3) decision-making is inseparable from building trust and connecting internal networks. Originality/value: This study contributes to leadership research by showing how everyday managerial activities - such as listening, supporting, making decisions, protecting, and connecting - were enacted and recognized as leadership during crisis. We argue that these practices gained significance not through individual competence alone but through relational processes of role attribution, thereby offering a more situated understanding of leadership in healthcare crises.