Prerequisites for ethical leadership: insights from health and social care leaders

Purpose This study aims to explore frontline and middle-management leaders’ experiences of ethical leadership in health and social care and examine the prerequisites associated with its enactment in everyday work. Design/methodology/approach Semi-structured interviews were conducted with 16 health and social care leaders and analysed using Braun and Clarke’s reflexive thematic analysis. The study adhered to the Standards for Reporting Qualitative Research and the Consolidated Criteria for Reporting Qualitative Research. Findings Five interrelated themes described the prerequisites for ethical leadership: its fundamental value-based nature; leaders’ internal ethical capability; human interaction and trust; organisational structures and culture; and ethical agency within hierarchical systems. Ethical leadership was described as a central aspect of managerial work, grounded in client-centredness and professional integrity, yet its enactment was perceived to be constrained in contexts characterised by unclear strategic direction, hierarchical pressures and competing organisational demands. Practical implications Strengthening ethical leadership may require multi-level support addressing individual, relational and organisational conditions. Organisations can foster these prerequisites through coherent strategic direction, transparent decision-making processes and systemic investment in relational practice. Supporting these conditions may help reduce moral distress, improve staff retention and enhance patient safety by enabling ethical leadership to be consistently enacted in practice. Originality/value This study provides new empirical insight into the prerequisites associated with ethical leadership in health and social care. By reframing ethical leadership from an individual attribute to a systemic capability, the study highlights the individual, relational and organisational conditions associated with sustaining ethical practice in complex health and social care environments.