Leadership, organisational culture and workforce engagement in the NHS: a qualitative study of healthcare management dynamics

PURPOSE: Despite extensive research on leadership and culture, limited qualitative evidence explores their interplay in high-pressure National Health Service (NHS) environments. This study investigates how leadership styles and organisational culture influence healthcare professionals' engagement and performance within the UK NHS, examining the mechanisms through which leadership behaviours and cultural norms affect professional engagement and performance, and developing actionable insights for improving workforce motivation and patient outcomes. DESIGN/METHODOLOGY/APPROACH: Guided by Transformational Leadership Theory and Schein's Model of Organisational Culture, this study adopted a qualitative interpretive approach. Semi-structured interviews were conducted with 20 healthcare professionals across 10 NHS hospitals in the UK. Data were transcribed verbatim, coded and analysed using thematic analysis, integrating both deductive and inductive approaches to capture rich, context-specific insights into leadership, culture and engagement. The study followed the COREQ checklist to ensure methodological rigour and transparency. FINDINGS: Three overarching themes and key insights emerged: Transformational Leadership (open-door policies and brainstorming), Organisational Culture (patient involvement and psychological safety), and Professional Engagement (inclusivity, shared purpose and innovation). Professional engagement mediates the relationship between leadership, culture and performance, enhancing staff motivation, innovation and patient care. A new conceptual framework illustrates these interdependent dynamics and provides practical guidance for NHS leaders and policymakers. ORIGINALITY/VALUE: This study advances Transformational Leadership Theory and Schein's organisational culture model by demonstrating their interactive effects in high-pressure healthcare contexts. It contributes theoretically by identifying context-specific mechanisms of engagement and practically by developing a framework to strengthen leadership effectiveness, cultural alignment and professional engagement in the NHS.