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.