Strategizing success: advancing women's leadership and careers in healthcare through a positive gain spirals Open Access

Effective leadership remains a critical determinant of team cohesion and organizational success (Englmaier et al., 2025), and within the field of human resource management (HRM), leadership capability is directly linked to succession planning, talent retention, and long-term workforce performance. Growing evidence suggests that gender-diverse leadership contributes positively to organizational profitability, innovation, and resilience (Glass and Cook, 2018; Sieweke et al., 2023). Despite these benefits, women continue to face persistent barriers to career development and progression into leadership positions (Jayashree et al., 2021). This limited career progression is particularly noticeable in the healthcare sector, where women make up most of the workforce yet remain underrepresented in senior leadership roles (World Health Organization, 2019; Pérez-Sánchez et al., 2021; Lux, 2024). In the healthcare industry, the workforce is predominantly female. Globally, 71% of healthcare workers are women (Pincha Baduge et al., 2024). Women also make up about 89% of the global nursing workforce (Pincha Baduge et al., 2024; Borger et al., 2025). However, leadership positions do not reflect this distribution. Only about 25% of leadership roles are held by women (Borger et al., 2025).

A similar pattern exists in Australia. Cohn et al. (2021) found that women hold 53% of positions on Australian public health boards, showing gender parity in overall board membership. However, women remain underrepresented in the most powerful chair positions, where they hold only 45% of positions. In some states, the representation is even lower. For example, in New South Wales, it drops to only 13%.

This imbalance reflects entrenched gendered hierarchies that limit women's upward career mobility despite their substantial contributions to frontline service delivery and organizational outcomes (Hu et al., 2022). Although the representation of women in strategic roles has increased in recent years, the metaphorical “glass ceiling” remains a significant HRM challenge, affecting recruitment, promotion, and leadership succession processes across industries. Drawing on a systematic review of 87 studies, Gierke et al. (2025) demonstrate how organizational context factors and HR practices across the employee lifecycle, from recruitment and selection through development, appraisal, reward, and retention, can shape women's access to and progression in leadership positions.

Research has consistently shown that dominant perceptions of “successful leadership” and influence are often aligned with masculine traits (Guillén et al., 2018; Round et al., 2025). In healthcare, this perception is reinforced by institutional apathy, masculinized leadership norms, and systemic bias, which influence HRM processes such as promotion decisions and leadership selection (Gauci et al., 2022). Healthcare organizations not only reflect these gendered inequities but also reproduce them through talent management practices that normalize male-dominated leadership structures. Based on 15 years of multi-country gender research, Newman and colleagues (2023) argue that healthcare organizations systematically reproduce gender inequality through structural practices, such as occupational segregation, biased promotion criteria, gendered assumptions about leadership competence, and tolerance of harassment or discrimination. Barbour (2024) highlights that even when leadership positions are provided to women in healthcare, it is more of a “glass cliff” phenomenon where women are appointed to leadership positions during crises, effectively setting them up to fail.

Using Hobfoll's (1989, 2001) Conservation of Resources (COR) theory, much of the existing research has examined these dynamics through the well-documented concept of loss spirals (van't Foort-Diepeveen et al., 2021). Loss spirals describe a downward trajectory in which individuals experience repeated or compounding resource loss, leading to escalating stress, diminished career confidence, reduced capacity to meet performance expectations, and further loss (Hobfoll, 1989). This can manifest in deferred career progression, missed development opportunities, and attrition from leadership pipelines. While this deficit-focused perspective has been valuable in identifying barriers, less attention has been paid to the organizational policies and individual strategies that enable women to sustain upward career mobility.

In response, our study shifts the focus toward understanding the conditions under which women succeed in advancing their careers. Drawing on COR theory, we develop a framework for understanding positive gain spirals, processes through which women accumulate, reinvest, and leverage resources to progress into and sustain leadership roles. Because women's leadership experiences differ across national systems, we focus only on the Australian healthcare sector. Rather than focusing on deficit or exclusion, we take a strengths-based perspective that considers both organizational systems and individual agency. This allows us to examine how HR practices, such as leadership development, mentoring, and supportive work environments, interact with women's resource-building efforts. Using qualitative data from Australian healthcare professionals, we explore how women navigate power, identity, and opportunity within gendered organizational settings.

Hobfoll's (1989, 2001) COR theory provides a useful framework for understanding how individuals strive to achieve career success and protect their well-being in competitive, resource-constrained organizational environments. The theory is built on the premise that people are fundamentally motivated to acquire, preserve, and build valued resources, whether these are material (e.g. income, time), social (e.g. networks, professional support), psychological (e.g. self-esteem, optimism), or condition-based (e.g. employment security, job status).

We thereby adopt the broad COR definition of “resources” but operationalize the construct in a way that is explicit and traceable in the analysis. During coding, we treated any asset, condition, or personal capacity as a resource when (a) participants described it as valuable, (b) linked it to coping with or reducing demands (such as workload strain, bias, or caregiving penalties), or (c) explained how it could be accumulated, protected, or invested to support future career progress. This approach is consistent with the Conservation of Resources (COR) theory's emphasis on resource investment and gain spirals (Hobfoll, 2001; Bardoel and Drago, 2021). This meant distinguishing between discrete resources (e.g. a senior sponsor, a stretch assignment, protected time, formal recognition, access to decision forums) and resource-enabling contexts that bundle and channel multiple resources. For example, we refer to a “supportive work environment” as a higher-order, condition-based configuration that operates as a resource in itself and as a passageway; a context that increases (or constrains) access to other specific social, material, and developmental resources such as flexible policies, inclusive norms, career visibility, mentoring, and fair evaluation (Hobfoll, 2001). Likewise, we conceptualize “dynamic authenticity” as a psychologically and relationally valued personal resource. Our participants framed it as a capacity to navigate identity demands in ways that conserve energy (reducing emotional strain) while building credibility, influence, and trust. These resources can be reinvested into leadership opportunities and network access over time (Kossek and Buzzanell, 2018).

COR theory emphasizes that the threat of losing resources creates more psychological strain than the benefit derived from gaining them (Wells et al., 1999).This means employees are particularly vulnerable to stress when their resources are threatened or depleted. In response, they often adopt protective behaviors to prevent further loss and invest strategically in opportunities for recovery and career progression (Hobfoll, 2001). In organizational contexts, these dynamics are closely tied to processes such as workload allocation, promotion decisions, and leadership succession planning. COR theory further highlights that resource loss has a greater impact than resource gain, and that deliberate investment is required to create future gains (Bardoel and Drago, 2021).

In the workplace, individuals face ongoing demands on their time, emotional energy, and sense of control, which can result in stress, burnout, and disengagement (Halbesleben and Buckley, 2004). HRM interventions such as workload management, targeted training, and employee recognition programs can help mitigate these risks. Employees also adopt proactive strategies to invest their remaining resources, such as seeking mentorship, building alliances, or pursuing high-visibility assignments, that enhance their capacity to cope and succeed over time (Ng and Feldman, 2012). COR theory distinguishes between acceptance resilience, which maintains continuity, and strategic resilience, which enables change and requires additional resources (Bardoel and Drago, 2021). Both forms of resilience have implications for practices like career development programs and leadership training, which can either reinforce existing capacities or boost career progression.

One aspect of COR theory particularly relevant to leadership development is the concept of positive gain spirals, a self-reinforcing process in which the initial accumulation of resources enables further acquisition, creating compounding career advantages over time (Hobfoll, 2001). For example, when an employee receives professional recognition or developmental support, this can strengthen confidence and motivation, leading to improved performance, expanded professional networks, and access to future leadership roles. In contrast, loss spirals, where resources are depleted without replenishment, can undermine career potential. Longitudinal studies have shown that job insecurity at one point in time negatively affects life satisfaction and increases the likelihood of continued insecurity (Jiang et al., 2025), highlighting the importance of stable, supportive organizational systems.

When applied to leadership in healthcare, the positive gain spiral provides insight into how some women can build momentum in their careers despite systemic challenges. While women in healthcare may encounter leadership stereotypes, undervaluation of collaborative leadership styles, or penalties associated with caregiving responsibilities (Eagly and Heilman, 2016; Hoyt and Murphy, 2016), access to key resources, such as senior mentorship, visibility in decision-making forums, and early leadership opportunities, can initiate reinforcing cycles of advancement (Fitzsimmons and Callan, 2016; Kark and Buengeler, 2024; Lyness and Grotto, 2018). For instance, a female healthcare professional promoted into a leadership role through a structured succession plan may develop stronger self-efficacy, enabling her to seek further challenges, lead high-impact projects, and gain broader institutional recognition.

Relational resources are particularly important in healthcare leadership, where collaboration, emotional intelligence, and clear communication are critical to team and patient outcomes. Female leaders often excel in these competencies, using them to build trust, cohesion, and support within teams (Gipson et al., 2017; Hentschel et al., 2019). These capabilities, when reinforced through HRM practices such as 360-degree feedback, peer recognition programs, and team-based leadership training, can strengthen leaders' resilience and reinforce their professional identity (Kossek and Buzzanell, 2018; Lau et al., 2023). As trust and credibility grow, access to new strategic networks, decision-making responsibilities, and assignments increases, further strengthening the gain spiral. Over time, these cumulative effects can lead to improved job satisfaction, a stronger sense of purpose, and sustainable career progression (Greer and Kirk, 2022). The benefits are not limited to tangible outcomes such as promotions and pay increases; they also include psychological gains, such as enhanced confidence, motivation, and perceived legitimacy, which are essential for effective leadership (Salanova et al., 2010).

This study applies COR theory to explore how women in healthcare accumulate, leverage, and reinvest resources to progress into leadership roles. Rather than focusing solely on individual resilience or systemic barriers, we examine how HRM systems, such as inclusive leadership pipelines, equitable performance evaluation, structured mentoring, and targeted professional development, shape access to resources and influence whether positive gain spirals can emerge. In doing so, we address the following research questions:

By examining these questions, we aim to demonstrate how resource accumulation interacts with organizational systems and HRM practices to shape leadership pathways, providing insights into how healthcare organizations can design environments that foster sustainable and inclusive leadership development.

Following recent calls for more qualitative research in management studies (Pratt, 2025; Ratten et al., 2025), we adopted a social constructivist approach (Berger and Luckmann, 2023) to explore our research question through the lens of lived experience. We used thematic analysis to examine qualitative interview data, capturing how participants interpret, negotiate, and respond to gendered leadership dynamics in healthcare (Braun and Clarke, 2006). Aligned with prior research on gender and leadership in healthcare settings (e.g. Byrne and Chadwick, 2024; Lux et al., 2025), we purposefully recruited participants who could offer deep insight into leadership trajectories, resource dynamics, and organizational practices shaping women's advancement.

Our sample included experienced male and female leaders across healthcare organizations. Female leaders were uniquely positioned to reflect on how they accumulated and strategically mobilized resources, navigated systemic and interpersonal challenges, and overcame gender-related barriers throughout their careers. Male leaders offered complementary perspectives, shedding light on how they engaged with gender equity efforts, experienced initiatives aimed at promoting women's leadership, and interpreted their own roles in strategizing for inclusive leadership cultures within healthcare organizations.

Our research sample included 30 healthcare leaders from across several Australian states, working in health, social, and community care settings, as shown in Table 1. Participants were drawn from both industry and academic institutions. We used purposeful sampling to recruit individuals in leadership roles at various levels, including senior, middle, and frontline management, as well as academics with leadership experience or strong industry connections. We continued data collection to reach the saturation point. After reaching data saturation, we ended up with a final sample of 30 participants: 20 female and 10 male leaders. Recruitment began through our professional networks in academia and the healthcare sector. We also used snowball sampling, where participants recommended other suitable individuals. This approach helped us reach a geographically and professionally diverse group and is commonly used in qualitative research when participants are hard to access, such as those in senior leadership positions (Noy, 2008).

We included both female and male leaders to gain a more complete understanding of gender-related resources in healthcare leadership. Female participants shared detailed accounts of how they built and used resources, the barriers they faced, and the strategies they applied to navigate gendered challenges. Male participants offered insights into their views on gender equality, their experiences with initiatives supporting women's leadership, and how they perceived inclusive practices within their organizations. To protect participants' privacy, we removed identifying details and assigned each participant a unique identification number during data collection and transcription.

We conducted semi-structured, in-depth interviews to explore participants' experiences of their own and others' leadership progression journeys. Interviews were conducted via Microsoft Teams, which enabled participants to engage comfortably, facilitated smooth recording, and ensured accurate transcription. All interviews were conducted by the same researcher to maintain consistency throughout the data collection process. Interviews lasted up to two hours each, allowing sufficient time for reflection and discussion of participants' leadership experiences. The interview guide included questions focused on key themes such as leadership development, resource accumulation, gender-related barriers and facilitators, strategies for navigating challenges, and experiences related to women's advancement into leadership roles. All participants consented for their interviews to be audio-recorded and transcribed.

We analyzed the interview data using thematic analysis, a widely used and flexible method for identifying, organizing, and interpreting patterns of meaning within qualitative data (Braun and Clarke, 2006). Consistent with our first research question, which asked what types of resources enable women's advancement into healthcare leadership, our initial analytic focus was on identifying the various forms of resources described by participants. This ensured that early coding remained closely tied to participants' lived experiences rather than to any theoretical expectations.

Our analysis followed Braun and Clarke's (2006) five phases: familiarization, initial coding, theme construction, theme review, and theme naming. The primary coder first read all transcripts multiple times, taking detailed notes and documenting early impressions to build deep familiarity with the material. We applied an inductive coding approach (Corbin and Strauss, 2015), meaning that codes were generated directly from the data. At this stage, no theoretical concepts, including those from COR theory, were used as a coding frame.

During initial coding, first-order codes captured concrete ideas expressed by participants (e.g. “work-life balance,” “positive role models,” “visibility from stretch roles”). These codes were then grouped into broader conceptual clusters based on similarity and meaning. This iterative process produced second-order, data-driven themes such as supportive work environments, supportive communities, resolute mindset, and dynamic authenticity. To improve the trustworthiness of our analysis (Shenton, 2004), an additional qualitative researcher, who was not informed of the study's theoretical framing, independently coded approximately 17% of transcripts. The strong alignment between their emergent codes and those developed by the research team provides clear evidence that the themes reflect the participants' perspectives. This makes it less likely that the researchers' theoretical assumptions influenced the formation of themes.

After establishing the inductively generated themes, we turned to our second research question, which asked how COR theory might explain patterns of gain spirals and strategic resource investment among women leaders. At this later stage, our analysis became abductive, engaging iteratively with COR theory to interpret how the emergent themes related to concepts such as resource caravans, gain spirals, and resource investment.

In other words, theory was not used to generate the themes but to help explain them once they had been identified. This data-first, theory-second sequencing aligns with established qualitative guidelines (e.g. Timmermans and Tavory, 2012) and avoids presenting the study as purely grounded theory while acknowledging the legitimate role of theory-informed interpretation.

The thematic analysis revealed four underlying themes: supportive work environments, supportive communities, resolute mindset, and dynamic authenticity. Table 2 provides an overview of the data structure, including themes, supporting codes, and selected participant quotations.

A highly referenced theme by 21 participants was the importance of supportive work environments. Four features were highlighted. First, flexible policies, such as remote work options, part-time roles, and family-friendly programs, helped women balance leadership responsibilities with caregiving demands (Fritz and Van Knippenberg, 2018; Kalysh et al., 2016). As P10 noted, “Flexible working policies made leadership possible,” and P30 added, “Family-friendly workplaces empower women to pursue leadership roles.”

Second, positive workplace cultures were identified by 20 participants as essential for progression. Collaborative cultures and transformational leadership created encouraging environments where women felt safe to grow and contribute (Gipson et al., 2017; Kark and Buengeler, 2024). As P12 shared, “Collaborative cultures enabled me to grow and succeed,” and P5 noted, “Transformational leadership styles foster progress.”

Across interviews, women described how these workplace supports often provided the first opening for further development. Flexible arrangements made it easier to take on stretch assignments, while inclusive cultures gave women confidence to participate in leadership activities. Mentorship and support networks, mentioned by 23 participants, reinforced these effects by offering guidance, knowledge, and increased visibility. As P6 explained, “Mixed-gender mentorship boosted my career,” and P2 shared, “Senior female leaders guided me towards higher roles.”

Career visibility was also noted by all participants (n = 30). Being visible in promotion shortlists, leadership programs, and succession planning ensured that flexible or part-time work did not limit advancement. Together, these findings show that supportive work environments provide initial, externally supplied resources that make it possible for women to pursue opportunities and begin building the internal capabilities explored in later themes.

The second theme highlights how resources outside the workplace also shape women's leadership progression. Two subthemes were identified. Positive social culture, mentioned by 12 participants, reflected the role of partners, families, and communities in sharing caregiving responsibilities, offering emotional support, and encouraging women's career aspirations. As P9 stated, “Supportive partners and community are essential.” These supports eased home-based pressures and enabled women to take full advantage of developmental opportunities at work. Participants often described this home–work interaction as a necessary foundation, suggesting that external community support strengthened the benefits of organizational initiatives.

The second subtheme, positive role models, was noted by 14 participants. Seeing women succeed in senior roles inspired participants to pursue leadership and offered examples of how success could unfold in practice. As P18 said, “Seeing women in senior roles motivated me,” and P8 added, “Programs showcasing successful female leaders inspire others.” These role models often reinforced mentoring relationships at work and encouraged women to view themselves as capable of advancement. Together, supportive communities provided emotional stability, reduced strain, and reinforced belief in leadership potential. These community-based resources amplified the effects of supportive workplaces, showing how multiple sources of external support worked together to build early momentum in women's leadership development.

The third theme, resolute mindset, reflects the internal resources that developed as women engaged with supportive environments. Two subthemes emerged. Ambition and self-efficacy, mentioned by 18 participants, were described as essential for leadership development. Participants emphasized that believing in their leadership potential and actively seeking opportunities strengthened their progression. Encouragement from managers and family members often reinforced this confidence. As P8 noted, “Women must believe in themselves,” and P2 shared, “Encouragement from managers pushed me forward.”

Participants frequently linked their ambition and confidence to earlier experiences of support, showing how internal resources were built after women accessed enabling external conditions.

The second subtheme, persistence, was identified by 19 participants. Women described resilience and determination as central to progressing in the face of challenges. As P8 explained, “Resilience and perseverance have been crucial in my journey.” This persistence often became more pronounced as women gained confidence, took on new responsibilities, and received positive reinforcement from mentors and role models (Cross et al., 2017).

Overall, the data show a pattern where external resources laid the groundwork for the development of internal psychological resources. Ambition, confidence, and resilience strengthened as women experienced support, which then equipped them to pursue opportunities and overcome obstacles.

The fourth theme, dynamic authenticity, refers to how women balanced staying true to their values with adapting their leadership style to different contexts. Participants described authenticity as an ongoing process that required intentional adjustment, especially in environments shaped by traditional leadership norms. The subtheme of balancing empathy and assertiveness, mentioned by 16 participants, highlighted the importance of combining relational and decisive leadership behaviors. As P19 stated, “Balancing empathy with assertiveness is key,” and P30 added, “Authenticity helped me thrive in leadership.” Participants often explained that they found it easier to lead authentically once they had gained confidence, support from mentors, and cultural acceptance within their organizations. In this sense, dynamic authenticity appears as a later-stage internal resource that becomes possible through earlier external support and internal development. This suggests that authentic leadership emerges as women accumulate resources across their journey, contributing to continued momentum and reinforcing the cycle of growth.

Drawing from patterns across interviews, we developed a positive gain spiral framework of women's leadership as shown in Figure 1.

To identify the relationship between themes, we use close qualitative reading techniques rather than algorithmic or statistical inference because our interview transcripts were narrative rather than timestamped behavioral logs. This approach follows established qualitative guidance that treats participants' own causal language, for example, “because”, “that meant”, “so I could,” or “if X hadn't happened, I couldn't have done Y”, as valid empirical indicators of perceived causality (Saldaña, 2021). We reread each transcript and extracted only those passages in which participants explicitly connected one resource to another, such as family support enabling full-time study, flexible policies strengthening loyalty, or resilience facilitating visible authenticity, as shown in Table 3. Such explicit causal statements are recognized in qualitative research as “process tracing” within narrative accounts (Langley, 1999).

After identifying these causal segments, we compared them across participants and mapped them onto our four resource quadrants. This cross-case comparison allowed us to trace how resources accumulated and interacted over time, while maintaining fidelity to participants' meaning. This interpretive mapping reflects recommended methods for analyzing temporal and generative mechanisms in qualitative research (Langley et al., 2013). Importantly, this manual tracing preserved the integrity of participants' narratives by avoiding the imposition of external causal assumptions, while still enabling us to demonstrate the positive gains spiral evident in the data.

Our model (Figure 1) is a theoretical interpretation that integrates the themes into a process-oriented explanation of how resources build over time. Supportive work environments and supportive communities provide the initial external resources. As Table 3 shows, the analysis suggests that these two external resources not only influence one another, but they also work together to rebalance the broader system of external resources. Supportive work policies, such as the newly introduced 14-week parental leave for men, extend beyond the organization by reshaping caregiving patterns within families and communities (P2). Furthermore, these external supports help women build internal resources such as ambition, confidence, resilience, and authentic leadership. These dynamics highlight that external resources do not operate in isolation; they influence one another and, in doing so, indirectly strengthen internal resources such as confidence, efficacy, and sustained career momentum.

As internal resources grow, women are better positioned to pursue opportunities, navigate challenges, and express adaptive leadership styles. Their increased capability and visibility then reinforce the impact of organizational and community support, creating a continuous cycle of resource gains. While participants described their experiences retrospectively rather than as a step-by-step sequence, their accounts consistently pointed to interactions between external support and internal growth. The positive gains spiral captures this pattern and offers a theoretically grounded explanation of the dynamics of resource accumulation in women's leadership development.

This study examines how women in healthcare accumulate and use resources to advance into leadership roles. We draw on COR theory as the guiding framework. Specifically, we aimed to address two research questions: (1) What resources enable women's progression into healthcare leadership? (2) In what ways can COR theory explain gain spirals and strategic resource investment among women leaders in healthcare? Our findings contribute to leadership and HRM research by identifying a reinforcing gain spiral that connects supportive organizational environments with key psychological resources. Together, these elements strengthen leadership pipelines and support long-term career sustainability.

Although COR theory provides the foundation for this study, some themes, particularly dynamic authenticity, are not explicitly defined as resources within the theory. However, our participants consistently described authentic behavior, self-presentation, and openness to change as important in how they managed challenges and gained additional resources. These accounts suggest that authenticity acts both as a personal strength and as a relational mechanism that helps build trust, visibility, and support from others. By presenting dynamic authenticity as a relational and psychological resource, alongside the established resource categories in COR, this study highlights some limits of the theory and suggests additional resource pathways reflected in participants' lived experiences.

Our findings reflect the socio-technical environment of the Australian healthcare sector. Although women make up most of the healthcare workforce, they still hold relatively few senior executive roles (Mousa et al., 2021). This “purple collar” environment creates a distinct dynamic. Healthcare organizations have high levels of workforce entry. However, women's progress toward leadership in this sector is often slower and more limited than in the corporate sector. Healthcare career structures also rely on “rigid credentialing”. For clinical staff such as doctors and nurses, career progression often slows once they reach the highest levels of hands-on clinical practice. In contrast, healthcare managers face barriers later in their careers when they try to move into executive roles. At this stage, the “boys' club” culture and traditionally masculine views of leadership become more visible and influential (Mousa et al., 2023).

Pincha Baduge et al. (2024) explain these barriers using the Ability-Motivation-Opportunity framework. They show that leadership ability often remains limited because women lack visible role models. Motivation may decline due to the “glass escalator” phenomenon. In addition, systemic biases against part-time work restrict women's opportunities. Healthcare organizations often operate through hierarchical and bureaucratic structures. As a result, the resource-gaining process identified in this study resembles patterns seen in other large public sectors, such as education and public service (Mastracci and Arreola, 2016). These sectors share similar prestige-based hierarchies and rigid career pathways. In contrast, the findings are less transferable to agile or entrepreneurial environments, such as start-ups, where organizational structures tend to be more fluid.

The analyses revealed that external resources, particularly supportive work environments and supportive communities, play a foundational role in initiating positive gains. In HRM terms, these elements correspond to policies and practices such as flexible work arrangements, targeted leadership development programs, structured mentorship, career visibility initiatives, and inclusive promotion processes (Costantini et al., 2025; Read et al., 2020). These external supports help protect women from common resource threats such as gender bias, work–life conflict, and professional isolation (Kossek and Buzzanell, 2018; Lyness and Grotto, 2018). They also create conditions that allow women to continue investing in their leadership development. Consistent with COR theory, individuals are inherently motivated to protect and grow their resources (Hobfoll, 2001). When women leaders have institutional support through inclusive HRM systems, they are more likely to retain and reinvest internal resources in leadership performance and career progression, rather than expend them solely to manage or defend against loss.

Once initiated, the gain spiral continues through the accumulation of internal resources, specifically the development of a resolute mindset and the practice of dynamic authenticity. These internal resources include ambition, self-efficacy, resilience, and the ability to lead with both empathy and assertiveness (Fitzsimmons and Callan, 2016; Hoyt and Murphy, 2016). From an HRM perspective, these capabilities align closely with leadership competency frameworks and can be reinforced through coaching, 360-degree feedback, and tailored professional development programs. Each career success strengthens these internal resources, which in turn enhances leaders' confidence, adaptability, and effectiveness. Furthermore, these internal resources are not simply byproducts of success. Women actively and strategically use them in a reinforcing cycle where achievement strengthens mindset and authenticity, which can provide access to opportunities, expand leadership responsibilities, and support continued career progression.

While this study offers valuable insights into the resource dynamics shaping women's leadership progression in healthcare, several limitations should be acknowledged. First, the sample was limited to 30 participants within the Australian healthcare context. Although diverse in role and level, the findings may not be fully generalizable to other sectors or cultural settings where gender dynamics and organizational structures differ. Second, the cross-sectional nature of the interviews captures participants' perceptions at a single point in time, which may not fully reflect the evolving nature of resource accumulation or leadership development over the course of a career. Longitudinal studies would be valuable in tracing how internal and external resources interact over time. Third, while the study used a robust thematic analysis aligned with COR theory, the reliance on self-reported data introduces the possibility of social desirability bias, particularly when discussing sensitive topics such as ambition, authenticity, or institutional support. Future research could benefit from triangulating these insights with observational or organizational data to enrich and validate the findings.

This study contributes to COR theory by explaining how a positive gains cycle operates within women's leadership development in healthcare. Although COR research has traditionally focused on how people respond to stress, resource loss, or threats (Halbesleben and Buckley, 2004; Hobfoll, 2001), far less attention has been given to how resources accumulate and generate ongoing growth, particularly in gendered organizational settings. Many earlier studies have identified similar enablers, such as organizational support, mentoring, networks, inclusive cultures, confidence, and resilience, but these elements are usually examined separately and often through a challenge-focused lens that emphasizes barriers and coping. Our study takes a different approach by concentrating on the positive side of women's leadership development and showing how these elements work together as part of a connected developmental process.

A key contribution of our study is identifying the external conditions needed to initiate a positive gain cycle. Supportive workplaces and supportive communities function as foundational external resources that reduce pressure, buffer gender-related challenges, and create the stability women need to invest in their development. By specifying these external conditions, we strengthen COR theory by clarifying how positive resource cycles begin, extending the focus beyond individual responses toward a more contextual view of resource creation.

Our findings also explain the psychological mechanisms through which these external resources translate into sustained growth. As women gain support from organizations and their communities, they build internal resources such as ambition, self-efficacy, resilience, and dynamic authenticity (Hoyt and Murphy, 2016). These internal strengths help women take advantage of opportunities, navigate challenges, and shape an adaptive leadership identity. This offers a clearer understanding of how resource gains reinforce one another and why some women experience ongoing momentum in their careers (Halbesleben and Wheeler, 2015).

Another important contribution is the strengths-based framing of our model. Much research on women's careers focuses on obstacles, inequities, and the strategies women use to cope with them. While this approach is essential, it can overshadow the positive resources and conditions that enable women to thrive. Strengths-based approaches emphasize identifying and cultivating what works. For example, appreciative inquiry encourages attention to successful practices within organizations (Cooperrider and Srivastva, 1987), and strengths-based leadership highlights the value of developing existing capabilities. These perspectives support our decision to focus on positive organizational, community, and personal resources, offering a complementary lens to challenge-focused research and extending COR theory into a more proactive, growth-oriented direction.

Finally, our findings show that resource accumulation is not a passive process. Women actively reinvest their internal resources, such as confidence, resilience, and authentic leadership behaviors, to secure new opportunities and strengthen their external support networks (Fitzsimmons and Callan, 2016). This demonstrates that positive gain cycles involve both supportive environments and women's strategic agency. The study extends COR theory by demonstrating how individuals use accumulated resources to sustain upward career momentum.

Our findings offer evidence-informed guidance for healthcare organizations and individuals seeking to better support women's leadership development and progression. These implications are derived from recurring patterns in participants' accounts of their career experiences and should be understood as suggestive rather than definitive prescriptions for organizational change. We introduce the positive gain spiral as an exploratory framework that synthesizes how resource gains may accumulate over time through the interaction of individual agency and organizational conditions, as described by participants and supported by prior research. Consistent with this framing, leadership advancement is not portrayed as the responsibility of organizations alone or individuals alone; rather, participants' experiences indicate that progress tends to emerge where both engage in complementary ways.

At the organizational level, participants' accounts suggest that supportive work environments may enable women to sustain and build leadership-related resources. These environments were commonly described as combining flexible work arrangements, inclusive norms, career visibility, and access to structured mentoring. In HRM terms, such practices may be reflected in promotion frameworks, workforce planning processes, and leadership development initiatives that signal ongoing commitment to leadership capacity-building (Fritz and Van Knippenberg, 2018). Some participants perceived transparent recruitment and promotion processes, including the use of targets or formal criteria, as reducing informal exclusion and “boys' club” dynamics (Mousa et al., 2021). Visibility of leaders who had progressed through these systems was described as reinforcing the perceived attainability of senior roles and motivating continued investment in leadership aspirations (Lyness and Grotto, 2018). At the same time, participants emphasized their own role in seeking visibility, engaging with mentors, and positioning themselves for advancement opportunities.

Participants also highlighted the importance of professional communities that extend beyond formal policy. These included peer networks, access to role models, and informal support mechanisms that helped reduce isolation and workload strain (Kossek and Buzzanell, 2018). From an HRM perspective, such communities may be embedded within employee engagement initiatives, high-potential programs, or cross-functional projects. Several participants noted that sponsorship, alongside mentorship, was particularly valuable in translating capability into opportunity, especially when supported by organizational attention to gender disparities (Mousa et al., 2021). Individuals, in turn, described actively contributing to and drawing from these communities to access information, encouragement, and opportunities that supported leadership readiness.

Structured leadership development programs were frequently discussed as sites where internal psychological resources, such as confidence, ambition, adaptability, and self-efficacy, could be strengthened. These resources align with commonly used leadership competency models and succession criteria (Zaccaro et al., 2018). Participants suggested that development initiatives were most meaningful when learning outcomes were recognized within performance management or promotion processes.

At the individual level, women described intentionally applying newly developed skills, setting clearer career goals, and reinvesting these gains to expand their leadership impact. Consistent with prior research, participants emphasized the value of co-designing development initiatives with women as end-users to ensure alignment with their working realities and career constraints (Mousa et al., 2023).

Participants also described the importance of leadership cultures that recognize and value diverse expressions of leadership. Training managers to appreciate dynamic authenticity, where empathy and assertiveness coexist, was perceived as reducing pressure to conform to narrow leadership prototypes (Hentschel et al., 2019; Kark and Buengeler, 2024). Inclusive evaluation criteria play an important role in recognizing diverse leadership styles. Individuals use authenticity strategically to build credibility, influence, and relational trust. Participants also note that visible support from senior leaders, such as public recognition, resource allocation, and attention to advancement metrics, reinforces the legitimacy of leadership aspirations, even when it does not guarantee career progression.

Participants also emphasized the importance of day-to-day managerial practices. Team leaders and middle managers were described as shaping immediate conditions for leadership development through feedback, stretch assignments, and role modelling of inclusive leadership behaviors. HR functions may support these practices by incorporating leadership development responsibilities into managerial expectations and performance criteria. Individuals described proactively seeking feedback, engaging in peer learning, and capitalizing on development opportunities as ways of building leadership capital incrementally. Participants also highlighted the role of professional bodies and industry initiatives in providing mentoring, development programs, and cross-organization networks. These opportunities supplement what organizations provide internally.

These evidence-informed implications illustrate how repeated, mutually reinforcing resource gains, described by participants across diverse contexts, may contribute to more sustainable leadership trajectories over time. While we do not claim that these practices will necessarily produce pipeline or cultural change in any specific organization, the positive gain spiral offers a structured way to think about how individual experiences of support, opportunity, and agency may accumulate and become self-reinforcing. In this sense, the framework serves as a practical lens for reflection and design rather than a tested model of organizational causality. By foregrounding both individual experiences and organizational conditions, the gains spiral highlights how women's leadership progress may become more visible, more resilient, and more sustainable when supportive elements align over time.

This study advances knowledge of how supportive environments empower women leaders in healthcare using a positive gain spiral. Our findings reveal that external resources, such as supportive work environments and communities, initiate self-reinforcing cycles, strengthening critical internal resources such as a resolute mindset and dynamic authenticity, essential for women's progression into leadership roles. Practically, our framework demonstrates how healthcare organizations can strategically leverage initial successes among women leaders to foster sustained growth, resilience, and broader cultural transformation. Further research should explore how diverse healthcare contexts influence these resource dynamics, examining intersections of identity and organizational culture. Intentionally investing in environments that nurture women's leadership presents an opportunity for healthcare organizations to redress leadership gender equity experiences and thereby improve their organizational performance.