Abstract
Abstract
Purpose:
Leadership research typically treats paranoia and suspicion as dysfunctional traits linked to mistrust and reduced psychological safety. However, public healthcare systems operate under persistent threat conditions where disciplined scepticism may support risk detection and failure prevention. This paper introduces Paranoid Adaptive Leadership (PAL), defined as a context-sensitive leadership orientation characterised by structured anomaly detection and system-focused professional scepticism.
Design/methodology/approach:
The paper adopts a qualitative conceptual methodology grounded in Threat Rigidity Theory. It synthesises Moroccan public healthcare studies and comparative international research to identify boundary conditions distinguishing adaptive vigilance from dysfunctional paranoia.
Findings:
Evidence suggests that the primary risk in Moroccan public hospitals is not excessive surveillance, but weakened vigilance resulting in performative compliance. Where governance systems are standardised and learning-oriented, disciplined scepticism becomes stabilised and adaptive. Trust climates moderate vigilance, preventing suspicion from escalating into destructive paranoia.
Originality/value:
The paper reframes suspicion as a contingent governance capability in high-risk public healthcare contexts and extends threat-based leadership analysis into resource-constrained, reforming systems.