Background and Objective:
Leadership in healthcare is associated with several indicators related to health care performance both at local and supranational levels. A wide debate has been developed about which leadership model best fits the needs of different contexts. The aim of our study is to analyze the scientific output relating to three models of leadership (transactional, transformational and complexity leadership), to understand to what extent they have met the interest of the scientific community.

Methods:
We conducted a bibliometric analysis of the 100 most influential articles for each of the three leadership styles. We searched Scopus database using three different research strings including keywords like “Leadership OR leadership style” and, respectively, “transformational”, “transactional” and “complexity”. Articles were sorted according to the number of citations, median citation values of each string were calculated and Kruskal-Wallis (KW) test was used to verify that the distribution of the number of citations were significantly different. Research was then extent to the total number of results for each string, relative frequency of citations was calculated for each query.

Results:
The median number of citations for each 100 articles was respectively 24 for transactional leadership, 80 for transformational leadership, 207.5 for complexity leadership (KW p < 0,001). Relative frequency of citations was 4.8% [95%CI 4.75 – 4.98] for transactional leadership, 16.6% [95%CI 16.48 – 16.86] for transformational leadership, 78.5% [95%CI 78.28 – 78.70] for complexity leadership.

Conclusion:
Our research shows that the type of leadership that seems to best interpret the interest of academia is complexity leadership in place of traditional models linked to reward mechanisms or pure motivational incentive. This follows up with the notion that complex systems cannot be reduced to simplistic models of a one-size-fits-all cause-and-effect nature but require more complex analyses therefore more ductile and articulate leadership models.