Negotiating Collective Leadership Within Formal Governance: A Scoping Review of Healthcare Workers’ Experiences (2020–2026)

Healthcare organisations rely on expertise distributed among professions and organisational levels, but qualitative evidence on how healthcare workers experience shared influence alongside formal authority and accountability remains dispersed. This scoping review mapped and narratively synthesised qualitative evidence from the prespecified 2020–2026 review period on healthcare workers’ experiences of collective leadership and related collectivistic approaches. Following Arksey and O’Malley’s framework, five databases were searched, supplemented by reference-list screening and forward citation tracking, for English-language studies published from 2020. Study selection and data charting each involved three independent reviewers. Six studies met the inclusion criteria. They examined situational or distributed leadership, formal co-leadership, and a transition towards collective authority. Four themes addressed negotiating leadership in practice, collective leadership within formal structures, relational and organisational conditions, and learning, teamwork, and improvement. Influence shifted with expertise, task, role, and context, while responsibility, authority, and accountability remained differentiated. Participants identified trust, role clarity, continuity, protected time, recognition, and organisational support as important for enactment. The review’s conceptual contribution is to clarify how influence, responsibility, authority, and accountability can be distributed differently within collective leadership arrangements, informing governance, work design, and future research.