Exploring the Impact of Remote Leadership on Health Care Delivery: A Systematic Scoping Review

Abstract

Background

Remote leadership has gained increasing recognition and become possible across sectors. Still, this approach is relatively new in the healthcare sector. The literature shows that the dynamic interaction among digitalization, remote working, leadership, and culture in the healthcare sector is under-researched. This review aimed to investigate how remote leadership is defined and conceptualized in healthcare organizations, how it is practiced across Western and non-Western cultures, and how these practices impact the healthcare sector.

Methods

We conducted a scoping review and applied the JBI and PRISMA-ScR frameworks to guide it. Articles from PubMed, Scopus, and Web of Science were used as sources of literature. All studies were analyzed using descriptive and inductive thematic analysis.

Results

Of 5310 studies, 17 met the inclusion and exclusion criteria. Our findings identified 4 themes: key concepts of remote leadership, competencies needed by remote leaders, opportunities and challenges of remote leadership, and how remote leadership is practiced in Western versus non-Western cultures. Remote leadership impacted on health system, organization, and service delivery. Lastly, we found that remote leadership in relation to culture was implicitly explored and is associated with leadership styles.

Conclusion

This review indicates that conceptual clarity remains underdeveloped within the healthcare-specific literature. A notable finding was that cultural context remained underexplored, with culture frequently treated implicitly through leadership style rather than as a distinct analytical dimension of remote leadership in healthcare. Further research is needed to provide a comprehensive understanding that helps remote leaders manage remote work environments and enhance the sustainability of healthcare services in an evolving digital era.

Introduction

In an era where care is no longer confined to hospital walls and leadership transcends physical presence, the rise of remote work is reshaping how healthcare systems function at their core. Leadership in healthcare is crucial to these processes and is widely recognized as a key factor in strengthening health systems.¹ Simultaneously, globalization and advancements in technology,² reforms and decentralization in healthcare organizations,³, as well as the experience of the COVID-19 pandemic,⁴ have affected the organizational dynamics of health systems and altered the nature of leadership.² The abovementioned developments have impacted various aspects of healthcare significantly, one of which is the shift from traditional to hybrid and/or remote modes of working. This has unsurprisingly affected various leadership practices,³ including the expectation that leaders are flexible to the emerging trend of working remotely.² Findings in the literature also suggest that effective remote leadership is critical in the remote work context.⁴

The concept of remote leadership has been defined in different ways, for instance, through terms like virtual, online, distance, e-leadership, digital leadership,^2,5,6 and electronic-Human Resource Management (e-HRM).⁷ Remote leadership has also been described as a temporal leadership paradigm when the leader and members of the team are not in physical proximity or within the same geographical or spatial dispersion.⁵ In another study, remote leadership was described as when leaders and team members can interact remotely,⁶—across long distances—through digital or electronic channels.⁷ Before the COVID-19 pandemic, the potential of digitalisation in healthcare—employing digital and electronic channels in administrative and clinical work—was constrained by individual and organizational concerns, as well as by systemic challenges, such as a lack of legal framework. However, the COVID-19 pandemic has accelerated the adoption of new ways of using technologies and remote working. Since then, remote leadership has grown exponentially and been widely adopted within the healthcare sector.⁸ It has also been noted that implementing remote leadership also benefits healthcare organisations by reducing costs, supporting work-related well-being, and improving health outcomes.⁸

Despite its advantages, remote leadership also presents several practical challenges. In accordance with that, the literature mentioned about Industrial and Organizational Psychology—a branch of applied psychology—reported on how pandemics, like COVID-19, influence work and organizational dynamics, including the challenges and opportunities arising within remote working, such as the nature of communication, team cohesion, supervisor behaviors, knowledge sharing, and trust perceptions.⁹ Many studies have mentioned that building trust and fostering communication are common problems discussed in remote leadership.^3–7 A qualitative study on virtual leaders reported that informal communication, such as the coffee break at the office, could not be replaced by virtual coffee breaks in which people did not see each other directly. In essence, virtual or remote informal interactions are considered to be of limited feasibility and quality.¹⁰ Additionally, swift trust—the speed at which team members can establish trust in one another when collaboration occurs remotely—also remains a vital component of virtual work since it forms cohesive units among team members and acts as a glue.¹¹ Supporting this notion, literature also mentioned about task–technology fit—correspondence between task requirements, individual abilities and the functionality of the technology— is also a vital issue in remote work, as a good task–technology fit has a positive effect on individual performance.¹² Further, consistent with this, a study reported on media synchronicity (the extent to which the capabilities of a communication medium enable individuals to achieve synchronicity) also influences the success of remote work, because the use of synchronous (eg. videoconferencing) or asynchronous (eg. email) media affects the efficiency of communication.¹³ Taking the above-mentioned points into account, several points mentioned, healthcare, as a highly human-intensive sector where, in practice, most tasks are associated with communication and human interaction,⁶ requires remote leaders who possess the ability to understand and navigate these dynamics effectively. A study in Australia reported that healthcare leaders and many clinicians remained sceptical toward virtual healthcare as it was considered insufficiently comparable to traditional face-to-face healthcare.¹⁴ While virtual healthcare does not directly align with the concept of remote leadership, naturally, the structure of virtual care will require leadership embedded in a remote leadership concept, where interaction across the team occurs relationally, remotely, and technologically mediated.¹⁵

Due to increased remote work, where leaders and team members are often not co-located and communicate via technology, it is critical to consider task complexity and interdependence in virtual work environments. According to task complexity theory, leaders need to set clear rules on how they and their team members should communicate to improve team performance during complex tasks.¹⁶ Additionally, in situations of high task interdependence, task-focused leadership should not only assign tasks but also build trust and shared understanding to improve team performance.¹⁷ Furthermore, they should mold the interactions and relationships between team members.¹⁶

Leading teams remotely is challenging, especially when the team spans multiple locations or countries, which means that leaders need to respect and value the potential diverse cultures of their team members.¹⁸ Besides this, leaders may require embracing more individualised approaches that accommodate the differences in members’ values and orientations.¹⁷ Relatedly, the literature also shows that leadership is enacted differently in Western and non-Western contexts. In Western cultures, leadership styles such as transformational leadership are commonly portrayed positively, whereas in non-Western contexts, non-participative leadership is effective due to the common high power distance.¹⁹ The contrast underscores the influence of cultural values and paradigms, where Western culture tends towards decentralisation and innovation, while Asian, African, and Latin American cultures, for instance, emphasise hierarchy and collective harmony.²⁰ For example, in Japanese organisations, individualized negative feedback is held back or delivered civilly to ensure group harmony.²¹ In the literature, culture has been described as a complex multi-level construct that can be discussed at various levels of society. Six levels of culture have been identified and include supra-national (such as Western and Eastern civilizations), national (such as American and Japanese), industry (such as hospitality and tourism), occupational (physicians and lawyers), corporate (such as Disney and Hilton), and organizational levels (such as managerial practices and work attitudes). Another body of literature describes culture as global (macro-), national, organizational, group, and individual (micro-) levels of culture. Global culture shapes individual behaviour through top-down processes, while changes in individual behavior can act the other way around and reshape norms and values at the macro level.^22,23

Remote leadership is a relatively new approach in the healthcare sector, particularly within the healthcare delivery process,²⁴ and in how healthcare delivery is planned, organized, and delivered across interconnected macro (health systems), meso (organizational), and micro (service delivery) levels of service. Furthermore, interactions among healthcare delivery, digitalization, remote work, and remote leadership in the healthcare sector remain under-researched. The existing literature shows that leadership practices are shaped by the unique cultural dynamics inherent to each context. However, the application of remote leadership across diverse geographical contexts remains underinvestigated. So, what does it mean to lead when teams are dispersed across time zones, cultures, and digital platforms? This study delves into the evolving concept of remote leadership, unpacking how it is defined, understood, and enacted within healthcare settings. By examining its practice across both Western and non-Western contexts, we uncover not only the cultural nuances that shape leadership approaches, but also their tangible impact on organisational performance and patient care. Ultimately, this research seeks to illuminate what makes remote leadership truly effective in today’s digital landscape—offering insights that can foster stronger teams, more resilient systems, and better healthcare outcomes worldwide.

Methods

Study Design

For this study, we chose a scoping review because this approach is useful for examining emerging evidence,²⁵ mapping the depth and breadth of the topic, and producing findings that may be more nuanced in areas where the existing evidence remains unclear and insufficiently understood.²⁶ In this study, we mapped the existing literature and defined the key concepts of remote leadership and how it was practiced across varied geographical contexts, ie., Western versus non-Western countries/cultures. We also investigated the impact on healthcare organisations and the health system at the macro (national/system-wide), meso (regional/organizational), and micro (frontline/service delivery) levels.

Inclusion and Exclusion Criteria

The protocol for this scoping review was developed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), see Figure 1.²⁷ The Joanna Briggs Institute (JBI) Population, Concept, and Context framework guided the eligibility criteria for including papers in this study (see Table 1). To evaluate the methodological quality of the studies, we used the JBI checklists to appraise them (Supplementary 1). However, best-practice-oriented articles were not included in the critical appraisal. Afterwards, the PRISMA for Scoping Reviews checklist (Supplementary 2)^28,29 and PRISMA 2020 flow diagram for new systematic reviews³⁰ were used as reporting guidelines.

Figure 1.

PRISMA 2020 flow diagram for new systematic reviews.

Notes: *Number of records identified from each database or register searched.**If automation tools were used, indicate how many records were excluded by a human and how many were excluded by automation tools.

Table 1.

Parameters, Inclusion, and Exclusion Criteria

	Inclusion Criteria	Exclusion Criteria
Population	Physicians and/or nurses, and/or other health professionals	No description of physicians and/or nurses, and/or other health professionals
Concept	Description of remote leadership/virtual leadership/online leadership/distance leadership/ e-leadership/digital leadership or Descriptions that are related to when the leader and members are in spatial dispersion or Descriptions where leaders and team members can interact remotely across long distances through digital or electronic channels	No description of remote leadership or Description of remote leadership at non-healthcare organizations and/or health system levels
Context	Description of cultural dimensions and tendencies of Western and non-Western settings Western context: Western Europe, Northern Europe, Southern Europe, North America, Australia, and New Zealand Non-Western context: Asia, Africa, Latin America, the Middle East, non-European countries, and non-North American countries 2Healthcare organizations and/or health system levels
Literature type	Full-text published articles: original research, innovations, and best practices	Reviews, protocols, conference abstracts, books, commentaries, reports
Language	English-language literatures	Not English
Year of publication	From 2000 to date	Prior to 2000

Source, Search Strategy, and Selection

The literature sources were from PubMed, Scopus, and Web of Science. The search strategy utilized English keywords, including Medical Subject Headings (MeSH) terms and Boolean operators. As an example, the electronic search strategy for PubMed was provided in Supplementary 3. All papers identified in the literature were further deduplicated and unified using the Covidence system. Two authors, FM and JB, individually screened 4,859 studies based on their titles and abstracts. After addressing any discrepancies between the two, 51 studies were selected for full-text review. The 51 articles were reviewed by all authors, FM, JB, FD, and AJD. FM conducted 51 full-text reviews, while JB, FD, and AJD reviewed 17 articles each.

Data Extraction

Details of the reviewed papers, as described in Table 2 were provided, which included the authors’ names, the first author’s professional background, year, title, aim(s), literature type, method, framework, description of remote leadership, study population, setting, country of study origin, impact on healthcare organizations and health system levels, and context/culture. All eligible articles were entered into a sheet (Supplementary 4). FM provided and completed the extraction sheet of 17 articles, and later, JB, FD, and AJD revised and reexamined the articles involved before obtaining the outcomes.

Table 2.

Data Extraction

Extracted Data	Details
Author’s name	Names and surnames of authors
First author’s professional background	Professional background or discipline of the first author
Year	Year of publication
Title	Title of study
Aim(s)	Aim(s) of study
Literature type	Classification of included sources as either original research, innovations, or best practices
Method	Research design employed in the publication
Framework (if any)	The framework/model was applied in the study
Description of remote leadership	Key concepts of remote/virtual/online/distance/e-leadership/digital leadership
Study population	Participants included in the study
Setting	Location(s) or environment in which the study was conducted
Country of study origin	The classification of countries in which the study was conducted
Impact on healthcare practice	The scope at which the study’s findings affect practice, whether macro (national/system-wide), meso (regional/organisational), or micro (frontline/service delivery)
Context/culture	Cultural factors, such as the leadership approach/style described in the publication

Data Analysis

All articles, after extraction, were analyzed descriptively—presented counts as number and percentages—and then analyzed using inductive thematic analysis. FM and JB conceived the concept of the manuscript after familiarizing themselves with 17 reviewed studies. The representative ideas that were relevant to the research questions were identified and subsequently categorized into themes. FM prepared a preliminary report and consulted JB to further examine the themes and provide interpretations and reflections (due to his experiences and expertise in the leadership). A few discrepancies were solved, and FM and JB sequentially wrote and refined the manuscript for later discussion with the rest of the team, FS, and AJD. All members refined the manuscript and provided feedback to improve its clarity.

Reflexivity

All authors brought their thoughts and professional experiences to the discussion on remote leadership in healthcare in this manuscript. JB is a paediatrician and professor of medical education whose research focuses on equity and leadership development in postgraduate training in Aruba and the Netherlands. FM is a general practitioner, educator, and junior researcher based in Aceh, Indonesia, with a particular interest in physician leadership in underserved rural and remote health systems. FS is a gynaecologist and professor of health systems innovation in Amsterdam with expertise in qualitative and multidisciplinary research. AJD is medical immunologist, professor of medical education, and the director of a blood bank in Curacao.

The authors noted and acknowledged that, given the nature of inductive thematic analysis, the interpretation of findings may have been influenced by the team’s disciplinary backgrounds, leading us to emphasize healthcare-system perspectives rather than organizational psychology or other clinical physicians’ perspectives. Nevertheless, despite this bias, the authors believe that the diverse cultural background of the research team, alongside iterative discussions throughout the manuscript preparation, may have enhanced the analytical rigor and the research interpretations.

Results

In the identification phase, we retrieved 5310 studies from the databases, of which 451 were removed as duplicates (manually and by the Covidence system). We next screened the titles and abstracts of 4859 papers and, by applying inclusion and exclusion criteria, further excluded 4808 studies. 51 full-text articles were subsequently screened for eligibility, resulting in the exclusion of 34 articles. Seventeen articles were ultimately included in the review (see Figure 1).

Characteristics of the Summary of the Corpus

As depicted in Table 3, most articles were published during and after 2021 (76.47%), and 58.82% of these were written by author(s) with a professional background in nursing. Of the 13 articles (76.47%) that were identified as original research, four were best practice articles (23.53%), and the employed methods were predominantly qualitative studies (58.82%). More than half of the total articles (52.94%) used a framework in their study. In addition, nursing was the most common study population (41.18%) and hospital/university hospital and multisetting environments were the most common study settings (both 35.29%). Finally, regarding countries of study origin, the highest number of studies came from the United States (29.41%) and Finland (23.53%). To elaborate on the content and implications of our findings, we identified four themes: key concepts of remote leadership (see Table 4); competencies needed by remote leaders; opportunities and challenges of remote leadership; and leadership practices: Western versus Non-Western cultures.

Table 3.

Characteristics of the Corpus Literature, Total Article, N=17

Characteristic	n (%) References
Year of publication
2000-2010	2 (11.76)31,32
2011-2020	2 (11.76)33,34
≥2021	13 (76.47)3,7,8,35–44
First author’s professional background
Medicine	1 (5.88)41
Nursing	10 (58.82)7,8,33,35,38–43
Public health	1 (5.88)32
Psychology	2 (11.76)3,37
Others	3 (17.65)34,36,44
Literature type
Original research	13 (76.47)3,7,8,31,32,34–36,38–42
Best practices	4 (23.53)33,37,43,44
Methods
Qualitative studies	10 (58.82)8,31,32,34–36,38,40–42
Quantitative studies	3 (17.65)3,7,39
Not applicablea	4 (23.53)33,37,43,44
Framework
Yes	9 (52.94)3,31,32,34–36,38,39,43
Nob	8 (47.06)7,8,33,37,40–42,44
Study population
Physician	1 (5.88)41
Nursing	7 (41.18)8,31,33,35,38,39,43
Physician and nurse	1 (5.88)36
Nurse and midwife	1 (5.88)32
Collaboration with various health professionsc	4 (23.53)3,7,34,42
Health professions were not explicitly specified	3 (17.65)37,40,44
Settings
Hospital/university hospital	6 (35.29)32,35,36,38,40,42
Nursing home	1 (5.88)34
Multisettings	6 (35.29)3,7,8,33,39,41
No setting mentioned	2 (11.76)31,44
Not applicabled	2 (11.76)37,43
Country of study origin
Europee	8 (47.06)7,8,32,34,36,38,40,42
Northern Americae	6 (35.29)31,33,39,41,43,44
Middle Easte	1 (5.88)35
Multicountriesf	1 (5.88)3
Not applicableg	1 (5.88)37

Notes: ^aThose articles are best practice-oriented articles ^bNo framework used in the article ^cReferred to collaboration with at least two other health professions ^dThose articles are best practice-oriented articles ^eThe study origin: Europe consists of the United Kingdom, Sweden, Finland, and Norway, the Northern America consists of the United States and Canada, and the Middle East consists of Saudi Arabia ^fThe study was conducted in at least two different countries/regions ^gThose articles are best practice-oriented articles.

Table 4.

Themes and Representative Ideas

Themes	Ideas
Key concepts of remote leadership	Lead their teams remotely and virtually40,42
	Social influence7,8,31,33–38
	The distance involves organizational, cultural, social, and cognitive dimensions36
	(Specifically in the healthcare sector) many tasks centered on human interaction8
	Involved virtual teams31–33,43,44
	Lead virtual meetings43
	Show interest in virtual team7
Competencies needed by remote leaders	Interconnected domains: a) knowledge: understanding the principles and applications of digital health technologies, along with the ability to interpret, manage, and communicate healthcare data, b) skills: ability to adapt to new technologies, advocate for digital adoption, make evidence-informed decisions, and communicate clearly while leading teams through digital change, and c) attitudes: openness and optimism, confidence and caution, pointing to the need for training, support, and a growth oriented mindset.35
	Nine digital communication competencies essential for contemporary (nurse) leaders: ethical digital communication, digital leadership presence, engagement and advocacy, digital inclusivity, digital boundaries, networking, branding, impact measurement, and storytelling39
	a) knowledge (self-awareness, organizational history and goal, systems thinking, knowledge management, and risk taking), b) skills (communication, ability to motivate others and self, relationship building, creativity, and decision making), and c) commitment (passion an purpose, lifelong learning, team development, principle-center leadership, and valuing human resources)31
	a) communication, (b) decision making, and (c) self-initiative33
	Traits, cognitions, affects, and behaviors associated with leading remotely38
Opportunities and challenges of remote leadership	Opportunities: Costs and saving working time8,32,42–44 Administrative details43 Less time spent on commuting42–44 Flexibility in work hours8,37,42 Work-life balance3,8,37,42,44
	Challenges: Trust issues8,31,33,35,37,39,40,42,44 Lack of face-to-face interactions42 Well-being issues3,8,37,39,40,42 Inadequate leadership training in digital technology35,38,42 Limited digital literacy8,35,41 User confidence8,35,43 Technical limitations and inadequate infrastructure35 Data privacy/security,8,35 Digital inequities41 Time zone differences33 Home interruptions43 Technostress37 Burnout3,8,37,39,41 Lack of guidelines on remote leadership implementation7,8,42,43
Leadership practice (Western versus Non-Western cultures)	Traditional hierarchy-bound working practices still apply (United Kingdom)32
	Hierarchical structures, reluctance from senior leaders, and centralized governance limited (Saudi Arabia)35
	Gender-related challenges in remote work settings (Italy)37
	Recognize virtual team cultural norms, particularly where organizational cultures intersect with collectivist national cultures33
	Traditional leadership is no longer adequate in remote work settings33
	In the context of digital services, healthcare services need to adopt transformational and supportive leadership practices38
	Shared leadership is perceived to enhance performance in virtual teams44
	Effective leadership does not always require a fully democratic style34
	Collective leadership hindered change, whereas minimally collaborative remote leadership succeeded34

Key Concepts of Remote Leadership

Beyond decentralized organizational structures and large geographical areas,⁸ we found that 16 of the 17 reviewed articles highlighted that remote leadership has gained increasing recognition and become possible across sectors, including healthcare, particularly following digital transformation and the COVID-19 pandemic.^{3,7,8,31,33–44} Specifically, the volatile, uncertain, complex, and ambiguous (VUCA) environments resulting from the pandemic demanded leadership approaches that could easily adapt to the crisis context rather than a rigid leadership style. In addition, the necessary limited in-person interaction at the time led to greater reliance on information technology, which in turn rapidly compelled healthcare leaders to lead their teams remotely and virtually.^40,42 While remote leadership is commonly understood as a situation in which leadership is given to team members physically separated from the leader(s), the majority of the reviewed studies emphasized “social influence” as an important element in defining remote leadership. Remote leadership was thus defined as a process of social influence mediated through information technology.^{7,8,31,33–38} Technically, this means that remote leadership is not merely about highlighting the use of digital tools in leaders’ and members’ interactions but also involves behavioral and relational roles, including providing examples, fostering a supportive team culture, and empowering others.³⁵ Notably, another study—using the term “distant leadership”—suggested that distance between leaders and staff is not limited to geographical separation but may also involve organizational, cultural, social, and cognitive dimensions. These forms of distance can lead to different narratives, beliefs, and subcultures within an organization, shaping diverse perceptions of reality among staff.³⁶

One study, interestingly, found that remote leadership in healthcare differs from that in other sectors. This was because healthcare work relies heavily on interpersonal communication and professional presence when interacting with patients and other professionals, with many tasks centered on human interaction. Consequently, remote leadership in that context required distinctive approaches in which trust and collaboration were central.⁸ In the healthcare context, a separate article examining underinvested populations—including rural communities, racial, ethnic, and linguistic minority groups, and individuals with lower socioeconomic status—highlighted that, in the digital era, safety-net health leaders must address disparities in access to digital technologies for both patients and staff. Addressing these inequities is essential to ensure equitable participation in digital healthcare services.⁴¹

We further noted that five studies focused on virtual teams.^{31–33,43,44} A virtual team was defined as a team whose members were geographically dispersed from one another, from their leader, or from both, and were supported by technology.³³ Unfortunately, effective leadership in traditional in-person settings does not automatically translate into expertise in leading virtual teams and meetings.^43,44 When leading a virtual team, leaders need to consider both task and social dynamics.³¹ Additionally, effective virtual discussions between leaders and teams can facilitate a shift toward dispersed leadership and structures that improve communication and collaboration, and can circumvent the potential negative consequences of hierarchical structures.³² One important issue that emerges in leading a virtual team is that fatigue and anxiety are symptoms of a phenomenon known as “Zoom” fatigue. Hence, leaders play a critical role in how and when to hold virtual meetings.⁴³ Consistent with this, one study noted that remote leaders should show interest in their employees, for example, by asking how they are doing rather than simply saying they may contact the leader when necessary.⁷ Finally, one article provided five steps to lead a virtual team, including: establish the new reality of remote work, sustain and reinforce the team’s commitment to the organization’s culture, upgrade leadership communication practices, encourage shared leadership among team members, and perform an audit to ensure that the virtual employees are aligned with the organization’s cultural values and its mission.⁴⁴

Competencies Needed by Remote Leaders

We also identified that five articles provided categories of competencies that remote leaders must possess. The first article highlighted that successful remote leaders possess a range of competencies that include interconnected domains: a) knowledge: understanding the principles and applications of digital health technologies, along with the ability to interpret, manage, and communicate healthcare data, b) skills: ability to adapt to new technologies, advocate for digital adoption, make evidence-informed decisions, and communicate clearly while leading teams through digital change, and c) attitudes: openness and optimism, confidence and caution, pointing to the need for training, support, and a growth oriented mindset.³⁵ Another study provided nine digital communication competencies essential for contemporary (nurse) leaders, including ethical digital communication, digital leadership presence, engagement and advocacy, digital inclusivity, digital boundaries, networking, branding, impact measurement, and storytelling.³⁹ A different study identified key competencies in leading virtual teams and categorized them into knowledge (self-awareness, organizational history and goal, systems thinking, knowledge management, and risk taking), skills (communication, ability to motivate others and self, relationship building, creativity, and decision making), and commitment (passion an purpose, lifelong learning, team development, principle-center leadership, and valuing human resources).³¹ In a fourth study, three leadership skills were identified as important for leading virtual teams, including (a) communication, (b) decision making, and (c) self-initiative. Additionally, understanding the unique challenges of leading virtual teams was considered an essential skill for effective virtual leaders.³³ The last article reported that remote leaders require a new way of leading, hence they need to possess the traits, cognitions, affects, and behaviors associated with leading remotely.³⁸

Opportunities and Challenges of Remote Leadership

We noted some opportunities and challenges in implementing remote leadership. Regarding the opportunities, we found that remote leadership can bring some benefits to organizational work processes, including reducing costs and saving working time,^8,32,42–44 administrative details,⁴³ less time spent on commuting,^42–44 flexibility in work hours,^8,37,42 and work-life balance.^3,8,37,42,44

Additionally, regarding challenges, our review found that 9 of 10 articles highlighted the trust issue in remote leadership.^{8,31,33,35,37,39,40,42,44} Owing to the lack of face-to-face interactions in remote environments,⁷ remote leadership can impede the development of trust and communication.⁴² Remarkably, trust between the leader and employees constitutes an essential element of remote leadership.⁷ One of the studies we found highlighted that trust between leaders and teams is essential for enabling greater autonomy,⁴² which can support professional independence and discretion.³⁶ Trust also provides additional room for maneuver⁴⁰ and helps reduce workplace conflicts.⁷ In line with this, another study noted that, while autonomy tends to produce better outcomes than continuous control of team members, trust can strengthen commitment,⁸ and serves as a key factor in achieving team cohesion.³³

We also noted that six of the 17 articles underscored the issue of well-being arising from remote leadership.^{3,8,37,39,40,42} One study noted that, due to the transition to remote and hybrid work, there is a need to redefine well-being. Primarily in the medical industry, well-being is one of the most important issues.³ One article remarked that guidelines for leaders are also needed regarding how they take care of their well-being in remote work.⁴² Meanwhile, another study reported that the adaptability (creating changes, promoting organizational learning, and being customer/patient-focused) of remote leaders is the most significant trait that influences the well-being of hybrid employees.³

In addition, we also identified other challenges of the implementation of remote leadership in healthcare environments, including inadequate leadership training in digital technology,^35,38,42 limited digital literacy,^8,35,41 user confidence,^8,35,43 technical limitations and inadequate infrastructure, such as limited access to computers, unstable internet connections, and outdated software or systems,³⁵ data privacy/security,^8,35 digital inequities (due to barriers at multiple levels, including the individual, interpersonal, community, system, society, and policy),⁴¹ time zone differences,³³ personal situations such as home interruptions,⁴³ technostress,³⁷ and burnout.^3,8,37,39,41 Lastly, the review further showed that four of 17 studies reported a lack of guidelines for remote leadership implementation.^7,8,42,43

Leadership Practice: Western versus Non-Western Cultures

Only a few studies have examined remote leadership in relation to culture at the local or national level, and even within these, such relationships are being discussed implicitly and often associated with leadership styles. We found a few studies that explicitly reported on remote leadership in the context of Western and non-Western cultures. A study conducted in the United Kingdom showed that in Western health care systems, particularly for the nursing and midwifery professions, traditional hierarchy-bound working practices still apply.³² While a study in Saudi Arabia reported that hierarchical structures, reluctance from senior leaders, and centralized governance often limited (nurse) leaders’ decision-making authority, and constituted barriers to remote leadership.³⁵ It is also known that gender issues are closely linked to culture and organizational hierarchies; therefore, it is important that leaders are aware of gender-related challenges in remote work settings. One study found that the work-family interface and its relation to gender remain an issue. In many Mediterranean European countries, such as Italy, women are still considered primarily responsible for household affairs, even if they are employed or pursue careers. Managing work and family life simultaneously without institutional support is a major challenge for women, and this is especially daunting for women with young children.³⁷ In addition, effective coordination between leaders and team members should be grounded in cultural values and common norms to reduce cognitive distance among professional staff,³⁶ leaders must be sensitive to and recognize virtual team cultural norms since conflicts may arise from professional and cultural diversity, particularly where organizational cultures intersect with collectivist national cultures.³³

As mentioned earlier, remote leadership and (national) culture were mostly discussed indirectly by associating them with leadership style. One article, for example, pointed out that traditional leadership is no longer adequate to meet the demands of a rapidly changing, dynamic, and complex health care environment,³³ including remote work settings. Furthermore, another article reported that remote leadership was perceived as a distant, authoritarian style, potentially limiting fairness and employee participation.⁷ In the context of digital services, healthcare services need to adopt transformational and supportive leadership practices.³⁸ Consistent with this, another leadership style, ie., shared leadership, was also mentioned. Shared leadership is a process in which team members collectively share leadership responsibilities for managing team tasks.^40,44 Accordingly, shared leadership is perceived to enhance performance in virtual teams compared with more traditional leadership approaches.⁴⁴ Another study reported a contrasting finding, suggesting that effective leadership does not always require a fully democratic or highly inclusive style. In that case, the team already has clear goals, established routines, and sufficient professional competence to work autonomously, allowing implementation to proceed effectively without continuous direct involvement from the leader.³⁴ These findings were corroborated by another study, conducted in the nursing home settings in Norway, which stated that a strong collective and collaborative leadership style was found to hinder change in one setting, whereas a remote leadership style with minimal cooperation with staff proved successful in another.³⁴

Discussion

Remote leadership has become increasingly practiced across various settings within the healthcare sector. Hence, this scoping review aimed to investigate how remote leadership was defined and conceptualized in healthcare organizations, how it was practiced in Western and non-Western cultures, and, later, how such practices impacted healthcare organizations. Our findings show that the literature on remote leadership in healthcare settings has been growing, particularly during and after the COVID-19 pandemic.

Contextual Dimensions of Remote Leadership

The definition of remote leadership, as many studies have noted, primarily emphasizes the key elements of technology-mediated communication, geographical dispersion, and social-relational functions.^{7,8,31,33–38} However, our findings indicate that the identified elements interacted to shape remote leadership practice. Some of them included technological context, geographical and temporal distance, social, relational, and cultural context, task complexity and interdependence, organizational context, and leadership capacity. While we acknowledge that many studies have defined remote leadership, to the best of our knowledge, none have conceptualized the contextual dimensions of remote leadership in a way that allows readers to understand it tangibly. Based on the insights gained from this scoping review, we propose the following preliminary six-pillar framework that may help describe remote leadership in the healthcare organization (see Figure 2).

Figure 2.

A preliminary framework of remote leadership in the healthcare organization.

Notes: (I) Technological context In a remote setting, leaders must: Leverage digital tools to sustain visibility and workflow.^31,40,42,45 Ensure that team members receive comprehensive training and support to utilise these tools effectively.^{7,31,32,39,42,43} Proactively address any technical issues to mitigate disruptions to productivity.^{8,31,32,40,44} II. Geographical and temporal distance. Remote teams operate across multiple time locations, necessitating:Mindful scheduling: whereby leaders plan meetings and deadlines to accommodate diverse time zones.^32,34,49 Asynchronous work: promoting flexible, outcome-focused work that prioritizes outcomes over rigid schedules.^{3,37,41,42,45} III. Social, relational, and cultural context. To establish trust, remote leaders should:Foster psychological safety by conducting regular check-ins and maintaining open lines of communication.^3,32,41 Encourage informal interactions (like virtual coffee chats) to fortify team bonds.^7,8,32,36,43 Be intentional in recognizing individual contributions to enhance team morale.^{3,31,32,38,41} Cultural sensitivity: comprehend how varied cultural backgrounds influence communication styles and work habits.^{31,32,34,36,37,45},49 IV. Task complexity and interdependence. Managing complex, remote leaders should: Clearly define roles, responsibilities, and processes to prevent confusion.^{31,32,34,38,39,41,45} Decompose complex tasks into manageable steps with clearly established milestones.^{8,32,34,37,38,41} Facilitate collaborative problem-solving through shared platforms, ensuring that all voices are heard.^{31,34,36,41,45} V. Organisational context. Organisational leadership is shaped by policies, culture, and support structures. Remote leaders must: Align remote practices with organisational values and expectations.^{3,31,32,34,39,41,44},49 Advocate for necessary resources such as internet access and mental health support.^{3,31,32,38,39,41,42} VI. Leadership style and competence In remote environments, adaptability is crucial. Effective remote leaders must: Adapt leadership style to the organisation’s remote work maturity to effectively inspire and motivate virtual teams.^{7,8,32,34,36,38–40} Demonstrate emotional intelligence by recognizing and responding to virtual cues effectively.^3,34,38 Prioritise outcomes over micromanagement to empower team members and cultivate a culture of trust.^{8,31–34,38,40,41,43}

Implications for the Health System, Organization, and Service Delivery Levels

The implementation of remote leadership has influenced the healthcare sector at the macro (system), meso (organisational), and micro (service delivery) levels. First, at the health system level, we identified a need for clear guidelines for the application of remote leadership. Such guidelines must provide best practices, informed by knowledge sharing across organizations, to develop remote leadership and protocols that ensure their consistent implementation.⁸ Nevertheless, one study indicates that the feasibility of remote work varies with the nature of the work, and therefore, rigid government guidelines might not always prevail.⁸ Another implication for the health system level is that building and integrating more systemic remote leadership capacity development through professional training will be necessary,^{3,7,33,35,38,40–42,44} to increase the confidence and competencies of remote leaders. This is also in line with many studies highlighting that having little experience and a lack of training in leading virtual teams pose challenges for remote leaders.³⁸

Second, the implementation of remote leadership has brought many implications for the organizational context. In certain circumstances where remote leadership has been instituted, however, the literature emphasizes that both leaders and employees still appreciate face-to-face leadership.³⁸ This is because a hybrid work environment allows for flexibility, and occasionally, informal communication could be valuable in certain situations.^8,42 This is consistent with the literature that exhibits that direct communication supports relationship-oriented leadership. In this context, the remote leadership approach must focus on people and relationships, rather than on control and administration.³⁶ A potential shortfall of remote leadership is the reduced opportunity for spontaneous conversations and informal interactions, which serve as important social “glues” for strengthening organizational cohesion.³⁶ This is certainly an issue in health and social services, where work is highly human-intensive and where remote leadership is still a relatively new practice.^6,7 In-person meetings also continue to play a critical role in conflict resolution and the onboarding of new employees.⁷ Therefore, to address these challenges, remote leaders must find an optimal balance between remote and physical leadership presence, which may vary depending on organizational context and structure.⁴²

Conversely, physical distance may not necessarily diminish the effectiveness of communication, meaning that attention should also be placed on the quality of communication. Leaders should have strategies to counteract the absence of nonverbal cues, typically present in face-to-face interactions in the office environment,⁴⁴ and display more inclusive leadership styles. Having social skills may not be sufficient to lead in virtual environments. Therefore, leading remotely would require the capacity to create a positive work atmosphere with a sense of connectedness with the group.³⁷ Likewise, since organizational culture is shaped through social interaction, remote leaders need to employ new communication tools and techniques for their virtual employees.⁴⁴ Besides the concern about face-to-face versus virtual meetings, the implementation of remote leadership has also influenced how management teams address organizational problems. For instance, middle managers—who play important roles as the link between top management and the workforce—face various contextual pressures at both the sociocultural (eg., digitalization of work and workforce changes) and organizational levels (eg., work processes and work–life balance programs). Consequently, this may influence individual and organizational outcomes such as productivity, workaholism, and technostress.³⁷

Lastly, regarding service delivery, the remote leadership implementation has also affected how health services are delivered. For instance, during the COVID-19 pandemic, limited physical interaction created challenges for maintaining healthcare service delivery while balancing crisis response and routine care. In our review, remote leadership was essential for maintaining coordination to sustain service delivery under crisis conditions.⁴⁰ Another service delivery challenge is the well-being of healthcare professionals working remotely or in hybrid modes, which can, in turn, influence the quality of patient care. Given that healthcare work often involves emotional labor, ie., work that requires demonstration of emotions shaped by organizational expectations, remote leaders must support staff in adapting to changes and responding effectively to patients’ needs for optimal healthcare services.³

Culture and Leadership Practice

Culture creates a work environment in which leaders interact with their team members through policies, communication, and leadership practices to achieve organizational goals. Therefore, culture is widely recognized as a critical element shaping shared values and beliefs that guide interactions between leaders and members.⁴⁴ We believe that the sparse literature on how Western and non-Western cultures influence remote leadership is because remote leadership practices are a relatively new trend in healthcare. The included studies provided limited explicit findings in terms of cultural context. Consequently, most of the studies reviewed primarily focused on exploring the definition, concept, and factors that enable and hinder remote leadership practice, competencies required of remote leaders, and leadership styles, rather than examining culture as a complex and multi-level construct. This finding may indicate that the current literature on remote leadership in healthcare remains culture-blind, particularly in its exploration of how remote leadership is practiced within the multilevel model of culture in healthcare.

The literature states that culture is an integrated pattern of learned beliefs and behaviors shared among groups, including thoughts, communication styles, patterns of interaction, views of roles and relationships, values, practices, and customs.⁴⁵ It is often argued that culture is about how we think the world works. However, the language, knowledge, beliefs, assumptions, and values that shape how we see the world and our place in it give meaning to our experience. These interpretations that define our culture are what we pass down among individuals, groups, and generations.⁴⁶ Culture has also been described as an internalized and shared schema or framework that group members use to “see” reality and experience the world.⁴⁷ Referring to these various definitions, we can understand why cultural context is implicitly explored and frequently associated with leadership styles. Conceptually, culture and leadership styles are closely related, as culture can shape leadership styles, and vice versa. For instance, whilst one study mentioned that remote work can reduce workplace conflicts,⁴² other studies reported that conflict in virtual organizations may be more frequent.^8,33 To tackle this, therefore, remote leaders need to be aware that conflict may emerge as organizational and social boundaries widen, frequently driven by professional and cultural diversity.⁴⁸ Organizational cultures can override national cultures, particularly in collectivist contexts. Virtual teams are frequently highly diverse in professional and cultural backgrounds, yet they may become socialized into collectivist cultures.³³

With respect to leadership style, many practices shifted to shared leadership models during the COVID-19 crisis.⁴⁰ While transformational leadership remains widely viewed as the “gold standard”, the hybrid leadership model is likely to be a more sustainable model for future practice, especially in the context of remote working contexts.³ In the healthcare sector, new leadership approaches are needed due to the ongoing digital disruption and increasing remote working situations.⁸ In order to answer this, another study underscores that there is no one leadership style best suited for managing in a virtual environment. Healthcare leaders must be able to adjust their leadership style to the situation. Remote leaders must use a different leadership approach when leading virtual teams.³³

As in many previous studies, we acknowledge that this review has certain strengths and limitations. Regarding the strengths, as far as we know, this is the first review that examines culture in remote leadership, recognizing that culture is inherently embedded in every single daily practice of leadership and organization. Additionally, the review proposes a preliminary six-pillar framework of remote leadership in the healthcare organization that has not previously been well articulated in the literature and is particularly useful for understanding remote leadership in the healthcare context. The review also sheds light on the implications of remote leadership practices at three distinct levels in healthcare: the healthcare system (macro level), the organizational context (meso level), and service delivery (micro level). Identified limitations in this review included the use of only English-published literature. Due to the strict inclusion and exclusion criteria we used, only 17 studies underwent full-text review; therefore, the findings, including those related to cultural aspects, should be interpreted and applied with caution and may not be entirely generalizable to other contexts. Additionally, we acknowledge that leveling bias may have been present in our study, as best-practice papers were synthesized alongside empirical studies. Nevertheless, in the context of remote leadership in healthcare, these sources provide valuable practical, contextual, and experiential insights that may not yet be fully captured rigorously in the field where empirical evidence remains limited. Despite these limitations, this review offers a useful basis for future research that accounts for cultural contexts such as by applying a multi-level cultural framework. This may help remote leaders improve their understanding of how national, organizational, and professional cultures shape remote leadership practices in healthcare, thereby resulting in a good adaption to the “new normal” of remote leadership practice in contemporary healthcare organization.

Conclusion

This review indicates that conceptual clarity remains underdeveloped within the healthcare-specific literature. To fill this gap, we conceptualized the contextual dimensions of remote leadership, and proposed a preliminary six-pillar framework of remote leadership in healthcare organizations. Culture-wise, we conclude that the cultural context is implicitly explored and is associated with leadership styles. We also showed that the implementation of remote leadership has implications for the health system, organization, and the delivery of healthcare services provided to patients and communities. At the same time, we acknowledge that the framing of leadership we used to describe Western versus non-Western cultures in this paper relies on somewhat monolithic cross-cultural models. This has the potential to misrepresent “Western” and “non-Western” contexts as overly stable and internally homogeneous categories which is not the intent of this work. Therefore, Modern scholarship on cultural complexity, intersectionality, and cultural fluidity needs further exploration in future research. This will help develop a more comprehensive understanding of effective remote leadership practices that not only support improved remote work environments and enhance the quality and sustainability of healthcare services in the digital era, but are also tailored to local norms and cultural contexts. We also anticipate that, by conceptualizing the contextual dimensions of remote leadership within healthcare settings, this study may provide valuable references for educational leaders to incorporate competencies for leading virtual teams into curricula and for policymakers to develop guidelines for remote leadership practice in healthcare systems. Ultimately, strengthening the capacity of remote leaders is essential to leading remote teams effectively in response to the growing demands for remote leadership in contemporary healthcare environments.

Funding Statement

There is no funding to report.

Disclosure

Professor Jamiu Busari reports honoraria as a speaker to conferences at AMEE conference 2024., Basel, Switzerland, 24-28 August 2024, ICRE conference 2024., Ottawa, Canada, 17-20 September 2024, Dutch Orthopedic Society annual conference, Utrecht, May 22, 2025, NASKHO-conference, Curacao, June 20, 2025, 12th SIWF/ISFM Meded Symposium, Bern, Switzerland, September 24, 2025, AHRA symposium, Aruba, August 29, 2025, Black Physicians of Canada, Conference, Toronto, Canada, October 25, 2025, Developing Excellence Medical Education Conference, Birmingham, UK, December 8-9, 2025, and National Workforce and Education Conference, April 23, 2026; member of the DEI advisory council, Maastricht University; founder and director of JUMP18 foundation (www.Jump18.org). The authors report no other conflicts of interest in this work.