Developing Resilience-Informed Equity-Centered Leadership Frameworks from the Lived Experiences of Black Women Leaders in Healthcare
Open Access DepositedFrom Margin to Model
the indispensability of peer community, the omnipresence of structural barriers, the use of relational navigation as a survival and advancement strategy, and a spiritual or values-based orientation as a foundational leadership anchor. Four near-universal findings, present in 16 to 19 of the 20 primary accounts, further revealed that emotional labor, anticipatory cultural intelligence, boundary setting, and identity-conscious leadership are not incidental adaptations but constitutive features of Black women’s leadership practice. The study also surfaced four novel theoretical constructs not previously named in the leadership literature
Black Women, Healthcare Leadership, Public Health Leadership, Resilience, Self-Efficacy, Constructivist Grounded Theory, Black Feminist Thought, Intersectionality, Resilience-Informed Leadership, Equity-Centered Leadership, Health Equity, Leadership Framework, Resilience-Informed Equity-Centered Framework
the not-superhuman critique, the fix-it-then-lose-it pattern, sponsorship-capital denial, and intuition as disciplined competency. Collectively, these findings challenge dominant assumptions embedded in mainstream resilience and self-efficacy frameworks by revealing the structural conditions that shape, and at times distort, how confidence, persistence, and adaptive capacity are developed and deployed. Two original typologies form the main theoretical contributions of this research. The seven-model resilience typology identifies qualitatively different resilience structures, ranging from reactive and cyclical to constitutional and proactive, that go beyond the limited stress-response models common in the current literature. The seven-model self-efficacy typology broadens and partly challenges Bandura’s (1977) foundational four-source framework. Combined, these typologies create the Resilience-Informed Equity-Centered Leadership (RIECL) Framework, a comprehensive, practice-oriented model designed to support leadership development, organizational structure, and equity-focused institutional change. Moreover, the RIECL framework rejects the idea of a “default” leader. Frameworks that ignore the role of identity in leadership are not neutral
Developing Resilience-Informed Equity-Centered Leadership Frameworks from the Lived Experiences of Black Women Leaders in Healthcare Black women are among the most underrepresented and underresourced groups in senior healthcare and public health leadership. Despite documented expertise, sustained organizational contributions, and a persistent commitment to health equity, Black women leaders continue to navigate systemic structural barriers, erosion of credibility, and denial of sponsorship, which existing leadership frameworks have neither been designed nor equipped to address. The cost of this exclusion is not only organizational but also a direct threat to advancing health equity in the United States. This study responds to the critical absence of theoretically grounded, empirically derived leadership frameworks that center the lived experiences of Black women in executive roles.Using intersectionality theory (Crenshaw, 1989), Black feminist thought (Collins, 2000), and constructivist grounded theory (Charmaz, 2006), this study examined how Black women navigate structural challenges, cultivate resilience, sustain self-efficacy, and develop leadership identities in senior roles across healthcare, public health, and related sectors. Twenty-one Black women executives, representing academic medicine, health systems, governmental agencies, community health organizations, the military medical enterprise, and philanthropy, participated in in-depth interviews. Data were analyzed through iterative constant-comparison coding across four research questions addressing structural challenges, resilience architectures, navigation strategies, and the limits of existing leadership frameworks. Theoretical saturation was achieved across all 19 codebook categories, with 100% of the sample included. Four universal findings emerged across all 20 primary participants
they are based on the unspoken belief that a leader’s identity does not cause structural friction with their environment. For the Black women participants in this study, that belief has never been accurate. An effective framework for their experience must be built on a different basis—one that centers identity from the very beginning. This research makes empirical, theoretical, and practical contributions to public health leadership, organizational equity, and leadership development. It provides healthcare organizations, academic institutions, and policymakers with an evidence-based foundation for dismantling systemic barriers that hinder Black women’s advancement in leadership and for creating institutional environments where equity-focused leadership can thrive. The RIECL framework serves as a practical tool for practice, implementation, and future research. This study views Black women not as subjects of institutional concern but as innovators in leadership, emphasizing their knowledge and positioning their expertise as central to the future of health equity. Keywords
Abstract of the Dissertation From Margin to Model
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