Ethical leadership in health and social care depends on more than an individual leader’s character, according to a Finnish interview study. Leaders described it as a practice that relies on personal judgment, trust between colleagues and organisational conditions that leave people enough authority to act on their values.
The accounts also pointed to a practical problem: unclear strategic direction, pressure from organisational hierarchies and competing demands were perceived as constraints on ethical leadership. The paper reports these as leaders’ perceived constraints, not as an estimate of how often they occur.
Five pieces of the picture
The researchers identified five interrelated themes. Ethical leadership was described as the moral foundation of leadership, but one that can be difficult to define consistently when everyday decisions involve competing values and expectations. Participants placed dignity, autonomy, fairness and a focus on clients and patients at its centre.
A second theme concerned the leader’s internal ethical capability — an actively maintained resource involving self-awareness, emotional resilience and professional competence. The leaders portrayed ethical leadership as a continuing learning process shaped by knowledge, experience and reflection, rather than a fixed personal trait.
The remaining themes shifted attention to the environment around the leader. Communication, mutual trust and respect were described as the basis for ethical relationships, while peer support, time for reflection and psychological safety were seen as important for sustaining that work.
Organisational culture, structures, resources and communication shaped the room leaders felt they had to practise their values. Supportive structures, expert resources, collegial networks, clear communication and shared values were associated in the accounts with more consistent ethical practice; financial pressure and political steering were perceived as pushing efficiency ahead of values.
The final theme was ethical agency: the ability to make and carry out value-based decisions within a hierarchy. Leaders described a mismatch between responsibility and decision-making authority, along with one-way communication and multiple layers of management, as constraints on their influence. Top-down decisions, unclear guidance and organisational changes made without consultation were also perceived as weakening trust.
What the interviews can show
The study was based on semi-structured interviews with 16 purposively sampled frontline and middle-management leaders in Finnish public health and social care organisations. Interviews took place between January and March 2025 across four of Finland’s five national collaboration areas. Seven participants were in frontline leadership and nine in middle management; 15 were women and one was a man.
The researchers used reflexive thematic analysis and examined participants’ experiences alongside organisational and structural conditions. All 16 interviews were included in the final analysis, producing 174 codes from 4,117 references that were refined into five themes.
This design provides an interpretive account of how leaders understand ethical leadership, rather than a causal test of what improves care or staff outcomes. The themes should therefore be read as areas for further study, not as evidence that any particular organisational measure will produce better results.
The setting also matters. The research took place in Finland during significant organisational reform, which may limit how readily the findings transfer to other countries or more stable systems. Only leaders were interviewed, so staff and service users may describe the conditions differently; the researchers also note that one primary coder and the lead researcher’s professional background could have influenced the interpretation.
A question for organisations
The authors argue that ethical leadership should be treated as a systemic and relational capability. Their proposed response is coordinated support at several levels, including coherent strategy, transparent decision-making, leadership development, dialogue, adequate resources and stronger professional networks.
Future research will need to examine whether these conditions operate in different organisations, leadership levels and health systems, and how they change over time. It should also include staff and service users, whose experiences may not match those of leaders.
Paper data and sources
Original title: Prerequisites for ethical leadership: insights from health and social care leaders
Authors: Seere A, Suhonen R, Wiisak J
Journal/Repository: Leadership in health services (Bradford, England)
Status: Peer-reviewed
First online: 2026-08-19
DOI: Not available
Original paper · Full text