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The case study is based on field data, including in-depth semi-structured interviews with the main protagonist and related stakeholders of a large government hospital in Western India. After informed consent, the interviews with the stakeholders were conducted, transcribed and analyzed verbatim. In addition, secondary data from policy reports, newspaper articles and government websites was used to create the case. Since the protagonist works in the government system, her identity and other identifying information are disguised to maintain confidentiality.

The case study investigates the leadership challenges in a healthcare facility/hospital in public health. It traces the evolution of Dr Meena Sharma (Dr Meena), a leader in the government hospital ecosystem facing challenges such as infrastructural deficiencies, manpower deficit, healthcare bureaucracy and heavy patient load. This first-generation medical practitioner who transitioned from a private practice to a governmental one juggles balancing her demanding clinical practice, administrative responsibilities and teaching in the government hospital with her family responsibilities setup. However, in the wake of the upcoming LaQshya – Labour Room Quality Improvement Initiative by the Ministry of Health & Family Welfare, she strives to put together and motivate her team to work toward improving the quality of care during delivery and the immediate postpartum period at her hospital. Various issues arise in the organizational leadership for a woman leader such as adopting appropriate leadership style and using appropriate motivation and communication strategies for optimal performance.

The case study is aimed at teaching/training a) departmental heads of public and private hospitals, b) health program managers at higher and middle-level leadership roles, c) health policymakers at various levels in the government and other organizations and d) graduate and postgraduate students of public health, hospital management/administration. In addition to this, it can also be used for general management programs to teach organizational behavior, communication and leadership courses.

The COVID-19 pandemic has reignited the debate on effective leadership during a crisis. The study examined healthcare leaders' experiences, challenges and responses amid the COVID-19 crisis in India and the USA.

Thematic analysis culminated in developing a thematic framework that encapsulates the behavior of operational healthcare leaders in India and the USA to illustrate how they responded to the global pandemic. Twelve hospital leadership experiences were collected through in-depth Interviews.

The study highlighted comparable experiences and leadership responses from the USA and India. Thematic framework induced from three themes and eight sub-themes to illustrate how leaders handled unknown challenges of the pandemic, which they countered with increased accountability as a leader, extended need-based networking with inevitable experience of self-role distance, leading to their pragmatic approach and reinforcement of self-belief.

The study findings provide a way forward for revisiting existing crisis management frameworks and cross-cultural leadership theories in terms of behavioral aspects integration with the technical or operational aspects of crisis management.

Healthcare leaders aiming to rebuild hospital systems would benefit from the study by incorporating identified skills such as coping with emotional labor, self-role distance, perseverance, pragmatic approach, networking with extended stakeholders, and extra-role behaviors into training and mentoring programs.

Using a thematic analysis approach, the study’s two-country research design identified a homogeneous leadership response despite a distinct countrywide context.

There are few studies exploring leadership competencies for public health leaders in low-middle-income countries, including India. The purpose of this study is to discern the leadership competencies the public health leaders might need by adapting the LEADS framework of leadership competencies and understanding the characteristics of the Indian public health system that influence the practice of these competencies.

The authors followed a sequential multiphase mixed-method design. Phase I included a concurrent literature review and in-depth interviews of senior public health leaders in western India. Phase II was an online leadership competency survey (10 statements each for knowledge, skills and behaviors) of 88 district-level public health leaders. Phase III included focus group discussions with 33 district-level public health leaders to better understand survey results.

The practice of leadership competencies was determined by health system characteristics, governance and managerial processes, health system culture and sociopolitical environment in which the health system shared an interface. In total, 20 out of 30 competencies were categorized under the first two LEADS domains of “Leading self” and “Engaging others.” “Achieving results” was affected by the centralized nature of health programs’ planning and monitoring. The health systems context provided limited scope to practice competencies under the “Developing coalitions” and “Systems transformation” domains.

Findings from this study can help address gaps in leadership competencies and tailor leadership development programs.

Past research on leadership competencies in India has used Western frameworks without adaptation. Through this study, the authors tried to conceptualize and contextualize competencies for Indian public health leaders adapting the LEADS framework.