Purpose –

To explore how contextual factors affect the practice of learning-oriented leadership in fragmented healthcare systems.

Design/methodology/approach –

A qualitative case study using a participatory approach. Data were collected through semi-structured focus groups and interviews with leaders across hospital levels. Thematic analysis was applied.

Findings –

Four contextual factors were identified: (1) multiple external drivers (why), (2) diverse actors and perspectives (who), (3) emergent, unpredictable change (how) and (4) organizational resources and support (what).

The study refines the learning-oriented leadership framework in fragmented healthcare systems by emphasizing (1) cross-boundary leadership, (2) contradiction management, (3) leading for organizational learning under resource constraints and (4) differentiated leadership roles across levels.

Originality/value –

By integrating empirical insights with expansive learning theory, the study advances the learning-oriented leadership framework and offers strategies for leadership and policy in complex healthcare systems.