Purpose – This study aims to explore the impact of power games and leadership dynamics on organizational learning and resilience within healthcare organizations during the COVID-19 pandemic. By examining power struggles and sensegiving practices across hierarchical levels in two Swedish hospitals, the study investigates how these dynamics affected decision-making, crisis management and adaptive responses in a high-pressure environment.

Design/methodology/approach – This qualitative study uses semi-structured interviews with key healthcare managers and personnel responsible for crisis management. A deductive analysis is applied using theoretical frameworks on organizational learning, power games and sensegiving. Three critical events are analyzed to illustrate the effects of power dynamics and leadership practices on learning and organizational adaptation.

Findings – The study finds that power games and unilateral sensegiving significantly disrupted communication, decision-making and organizational learning. Informal leadership structures emerged to address immediate challenges, yet tensions with formal management highlighted the need to integrate these emergent practices into formal structures.

Practical implications – This study highlights that effective pandemic crisis management in healthcare requires balancing formal authority with inclusive and adaptive practices. Key implications include grounding sensegiving in frontline input, adopting flexible “plan-to-plan” approaches, involving hospital-level managers in decision-making, prioritizing practical over political solutions and fostering service-oriented leadership that enables rather than controls.

Originality/value – This study contributes to understanding how leadership and power dynamics shape learning and resilience during healthcare crises. By combining the insights with organizational learning and the Plan-Do-Study-Act cycle, it provides a novel perspective on integrating formal and informal leadership to enhance crisis management.