Navigating the "Moral Maze": A Flourishing-Centered Reflective Inquiry for Healthcare Leadership.

This paper aims to address the limited availability of reflective approaches designed for healthcare leaders to consider ethically consequential decision-making by introducing a flourishing-centered reflective inquiry into a single temporally structured process. To inform the development of this approach, we conducted a scoping literature review of peer-reviewed articles and scholarly book chapters published in English between 2015 and 2025. Because healthcare is often situated in academic medical centers influenced by higher education concerns, the search was conducted across both healthcare and higher education. Relevant literature set in a military context was retained when it illuminated leadership in settings where hierarchy or moral injury are relevant. Publications were screened for relevance to ethical leadership and were categorized and synthesized by setting, participant group, timing of reflection, and type of ethical tension addressed. The final corpus included 40 publications: 27 in healthcare, 11 in higher education, and 2 in military contexts. The review found that reflection is widely used in professional learning, clinical practice, and team-based settings, but is less often structured as a discipline for leaders' own ethical reasoning in operational and executive decision-making. Across the corpus, reflection appeared in retrospective, ongoing, and multi-phase forms, and ethical tensions repeatedly spanned individual, institutional, and societal goods. These findings informed the development of a reflective cycle in three phases: reflection-for-action, reflection-in-action, and reflection-on-action. Each phase is guided by an inquiry guide developed using the KNN Framework for Flourishing's elements of character, caring, and practical wisdom toward flourishing across socio-ecological systems. This paper contributes a conceptually integrated and practically oriented reflective inquiry for healthcare leadership that offers structured guidance for ethical discernment before, during, and after consequential leadership decisions.