Critical integrative synthesis
Evidence, method, and interpretive discipline
The report combines independent healthcare-leader research with a rapid critical review that tests mechanisms, limitations, counterfactuals, and the costs of turnover.
Healthcare reviews
Competencies, trust, turnover
Meta-analyses
Succession and performance
Field studies
Learning agility and teams
Theory
Tenure life cycles and adaptability
Original synthesis
PLEI and governance tools
Anchor sources
Evidence explorer
Hambrick & Fukutomi (1991)
Tenure mechanisms change over time.
Conceptual, not hospital-specific.Miller (1991)
Long tenure can weaken organization-environment fit.
Corporate historical sample.Brochet et al. (2021)
Firm value showed an average hump-shaped tenure relationship.
Firm value is not hospital performance.Crossland et al. (2014)
Career variety was associated with strategic novelty.
Novelty is not necessarily better performance.Dries et al. (2012)
Career variety was positively associated with learning agility.
Small, noncausal field design.Spanos et al. (2024)
Adaptation and collaboration dominated future competency themes.
Mixed academic and gray evidence.Varga et al. (2023)
Trust depends on ethical, supportive, accessible leadership.
Eighteen studies met inclusion criteria.Schepker et al. (2017)
Succession disrupted short-term performance.
Cross-industry evidence.Hermes et al. (2025)
Hospital CEO turnover can impose performance and failure risks.
Heterogeneous measures and designs.Leggat & Balding (2019)
Leadership churn can weaken quality governance.
Australian hospital context.
Tenure builds local knowledge; succession can disrupt; adaptation matters.
Variety may strengthen cross-context learning and trust formation.
The model, matrix, and PLEI require validation.
Career pattern alone cannot rank every leader.