A new paradigm: culturally competent leadership for indigenous health care

Purpose This paper aims to introduce an adapted, culturally competent leadership conceptual framework for indigenous health care, aiming to improve health access and address gaps in Western-centric leadership models. Design/methodology/approach A systematic literature review and thematic analysis of 32 peer-reviewed articles were conducted, guided by transformational and cultural sensitivity frameworks to adapt a conceptual framework to support health access in indigenous communities. Findings The adapted indigenous leadership conceptual framework (AILCF) includes 11 interrelated leadership themes – visionary leadership, supportive and empathetic leadership, adaptive leadership, integrity and ethical leadership, communicative leadership, courageous leadership, cultural competence, community engagement and relationship-building, historical trauma and healing, structural change and leadership in crisis – synthesized through transformational and culturally sensitive leadership lenses to support equitable health access and culturally grounded leadership in indigenous health-care settings. Research limitations/implications This qualitative review is limited by secondary data and geographic concentration within the USA. Practical implications AILCF fosters culturally attuned leadership development and practice within indigenous health organizations, providing pathways to equitable health access. Originality/value Unlike existing Western-centric models, the proposed framework incorporates historical trauma, relational accountability and cultural alignment, dimensions rarely reflected in traditional leadership theory. By reframing leadership as a culturally grounded, healing-centered practice, the AILCF offers a necessary contrast to dominant paradigms. This model contributes not by expanding leadership theory, but by disrupting its assumptions and advancing a more inclusive, context-specific understanding of what effective leadership entails in indigenous health-care systems.