Activating knowledge-based practice through healthcare leadership development: insights from the second study of a broader action research project

BACKGROUND: The increasing complexity of healthcare services underscores the urgent need for competent and resilient leadership. Yet research on leadership development in healthcare remains limited, with notable gaps across theoretical frameworks and organizational contexts. This study aimed to explore how participating leaders experienced pedagogical and relational principles, used in workshops during the development of a continuous leadership program in rural municipal healthcare. METHODS: This hermeneutic study is the second study of a broader action research project, conducted in a rural municipality and guided by an appreciative approach. Forty-one healthcare leaders from three leadership levels participated. Data was collected through 16 focus group interviews, participatory observations, and online surveys, and analyzed using Braun and Clarke's reflexive thematic analysis. RESULTS: The analysis identified one overarching theme: Activating a knowledge-based leadership community, supported by two interrelated themes: (1) Genuine involvement grounded in appreciative processes, (2) Facilitated interpersonal and professional knowledge development. CONCLUSIONS: This study demonstrates that activating knowledge-based leadership development in rural municipalities can be strengthened through the conscious choice of relational and participatory pedagogies. Our main contribution is a model of how pedagogical and relational principles-such as appreciation, involvement, and psychological safety-can be operationalized to build leadership capacity in municipal healthcare services. Leadership development appears most effective when embedded in shared experiences, supported by competent facilitators, and anchored in safe and appreciative environments. Within this context, psychological safety emerged as both a condition for, and a driver of, learning, interpersonal connection, and cultural change. The findings further highlighted the importance of continuity, organizational anchoring, and inclusive practices to sustain leadership development over time.