Medical leadership between motivation and organisational support: findings from a contemporary survey

Medical leadership is essential for high-value care, yet organisational conditions remain variable. This study aims to examine whether clinicians' motivation and perceived readiness to lead are matched by enabling infrastructures (e.g. protected time, decision support and shared-governance routines) and how gaps relate to perceived impact and clinician wellbeing.

The authors conducted an anonymous, cross-sectional online survey distributed internationally via professional networks and snowball sampling. Descriptive analyses compared clinicians and non-clinician leaders on five-point Likert items. Exploratory models assessed associations between cumulative "support deficits", perceived leadership impact and stress/burnout. In addition, a Shared-Governance Alignment Index was constructed. The survey was open from 4 November 2025 to 17 December 2025 and eligible respondents were clinicians or non-clinician healthcare leaders able to report on leadership, organisational support or clinician-administrator collaboration within their healthcare setting.

A total of 143 responses were analysed (107 clinicians; 36 non-clinician leaders), predominantly from Italy (76%). Clinicians reported strong interest in leadership roles [median 5 (4-5); 88% agree/strongly agree] and high self-rated preparedness [median 4 (4-5); 80% agree/strongly agree], but limited organisational supports, particularly protected time for leadership/quality improvement [median 2 (1-3)] and constrained access to decision support tools [median 3 (2-4)]. Increasing cumulative support deficits showed a dose-response relationship with lower perceived leadership impact (e.g. endorsement that leadership improves care quality: 94% with 0 deficits versus 53% with 2 deficits) and higher odds of stress/burnout. Clinicians also rated shared-governance conditions less favourably than non-clinician leaders, indicating persistent perceptual misalignment in clinician-administrator collaboration.

This study used a voluntary, cross-sectional survey, limiting causal inference and increasing susceptibility to self-selection, common method and social desirability biases. Measures relied on self-report rather than objective indicators of governance quality, decision-support availability or performance outcomes. The international, network-based sampling may under-represent some regions, specialties and non-clinician perspectives. Nonetheless, findings generate testable propositions for longitudinal and mixed-methods research examining how protected time, shared-governance routines and decision-support infrastructure influence leadership effectiveness and clinician wellbeing and whether closing the motivation-support gap improves organisational outcomes. Future studies should incorporate administrative data.

Organisations should complement leadership development with structural protections: defended time, accessible decision-support tools and clear shared-governance routines (co-owned decisions and aligned metrics). Without these supports, clinician motivation may translate into strain rather than sustained improvement.

Strengthening medical leadership through protected time, decision-support and shared governance can yield broader social benefits beyond organisational performance. When clinicians and administrators co-own improvement priorities, care processes become more reliable, reducing avoidable harm and enhancing public trust in health services. Better-supported leaders may also curb burnout and turnover, stabilising the workforce that communities depend on. More inclusive governance structures can amplify frontline and patient voices, supporting equity in service redesign and ensuring scarce resources are allocated transparently and ethically. These conditions may improve access, particularly for marginalised groups during pressures.

The study frames medical leadership as an organisational capability and identifies a "motivation-support gap". By associating self-reported structural deficits with perceived effectiveness and wellbeing, it offers actionable targets to strengthen clinician-administrator partnership and leadership sustainability. The revised framing also explicitly situates medical leadership within digital readiness, artificial intelligence-enabled decision support and health-information-system adoption as contemporary components of organisational support.