Abstract
INTRODUCTION: Research into management and leadership in healthcare has revealed that the organizational context influences quality improvement, which is why research is needed to better understand the particulars of leadership in the relatively unexplored field of prehospital emergency care. This includes aspects of managerial work related to managers' experiences and their understanding of their roles and existing operational routines. Therefore, this study aims to explore managers' experiences with management and leadership in the context of prehospital emergency care in Sweden. METHODS: A qualitative interview study design was conducted with 15 unit managers in prehospital emergency care from four of Sweden's 21 regions. The transcripts from the in-depth interviews were subjected to inductive content analysis and reported according to the Consolidated Criteria for Reporting Qualitative Research. RESULTS: Three generic categories related to the managerial role were identified: challenges, openness and trust, and experience-based leadership. The challenges managers faced were a. lack of physical proximity; b. staff needs for knowledge and competency development; c. staff level of responsibility related to operating procedures and guidelines; and d. work culture. Trust was developed through open and personalized communication, trusting relationships, authenticity, and empathic ability. Experience-based leadership was cultivated over time through practice, reflection, guidance from peers, theoretical leadership training, and the adaptation of organizational structures. CONCLUSIONS: We found the managerial role to be location independent, characterized by openness and trust, and cultivated through experience. In an environment characterized by academic training and work at distances, leaders manage individuals and remote teams while respecting individuals' independence. They supported staff competence development and their desire to take responsibility through open and trusting relationships established through creating opportunities for competency development and a "learning-by-doing" epistemology built upon reflective practice.