Systems and organisational change to advance gender equity in healthcare leadership: a mixed-methods protocol

Background: Despite comprising over 70% of the global healthcare workforce, women remain significantly underrepresented in healthcare leadership. Structural and systemic barriers persist across academic medicine, health services, and professional organisations, limiting career progression and leadership opportunities for women. Existing efforts often focus on individual-level interventions, overlooking the broader organisational and systemic contexts that shape leadership pathways. Urgent, coordinated action is needed to address gender inequity through sustainable, evidence-informed systems change. Methods: This protocol outlines the Organisation Change Management (OCM) workstream within the Australian Advancing Women in Healthcare Leadership (AWHL) initiative - a nationally implemented, multi-sector partnership. The initiative applies a mixed-methods, coproduction approach to implement and evaluate multi-level interventions aimed at advancing gender equity in healthcare leadership. Guided by the Consolidated Framework for Implementation Research, the Learning Health System framework, and the Reach, Effectiveness, Adoption, Implementation and Maintenance evaluation model, the study engages stakeholders across outer (policy, regulation, funding) and inner (organisational culture, leadership structures) settings to drive systemic and organisational changes to enhance gender equity in leadership. Data collection includes administrative datasets and policy documents, semi-structured interviews, and surveys across partner organisations. Findings will inform tailored interventions and an implementation toolkit, developed and evaluated through iterative stakeholder engagement. Discussion: This is the first national initiative to apply a systems-level, coproduced approach to gender equity in healthcare leadership, engaging strategic partners including health services, professional colleges and associations, government, and women in the workforce. By leveraging implementation science and systems change methodologies, the initiative aims to accelerate sustainable organisational transformation. The protocol provides a replicable framework for advancing equity in healthcare leadership and beyond.