Identifying Clinical Managers’ Leadership Competencies: A Systematic Review and Cross-Frameworks Mapping Using the CLCF

Abstract

Background/Objectives: Effective clinical leadership is a critical driver of healthcare quality, patient safety, and organisational performance. However, evidence on the leadership competencies of healthcare professionals in formal management roles remains fragmented. It is dispersed across professional groups, healthcare contexts, and conceptual frameworks, limiting opportunities for synthesis and cumulative knowledge development. This systematic review examined three questions: how clinical managers perceive their leadership competency; what challenges they encounter in exercising leadership roles; and what development mechanisms the literature identifies. Methods: A systematic review was conducted following PRISMA 2020 guidelines and registered in PROSPERO (CRD420261305279). Four databases were searched: Ovid MEDLINE, CINAHL, EMCARE, and Web of Science from January 2010 to February 2026. Two reviewers independently screened studies; methodological quality was assessed using the Mixed Methods Appraisal Tool (MMAT). Reported competencies were mapped to the five domains of the Clinical Leadership Competency Framework (CLCF) using narrative integrative synthesis. Results: Forty-nine studies were included across quantitative, qualitative, and mixed-methods designs from 24 countries. Competencies in the Working with Others and Demonstrating Personal Qualities domains were reported as strengths across the largest number of included studies. Competencies in Managing Services, Improving Services, and Setting Direction were reported as areas of weakness or developmental need across multiple studies. Leadership challenges included inadequate preparation, role ambiguity, limited authority, and organisational constraints. Development needs spanned formal training, strategic competency building, mentoring, and sustained organisational support. Conclusions: Clinical leadership competency is unevenly distributed across CLCF domains. This pattern reflects not only individual developmental gaps but also the organisational and contextual conditions that shape how leadership is enacted in practice. The findings support a contextual-relational model of clinical leadership. Both individual capability and enabling organisational conditions must be addressed to strengthen leadership effectiveness across healthcare systems.