BACKGROUND: New evidence on the digital competencies of healthcare leaders can provide essential knowledge for building training for the leaders to ensure high-quality patient care. OBJECTIVE: The aim of this mixed-methods systematic review was to identify the current best evidence from qualitative, quantitative, and mixed-methods studies on healthcare leaders' digital competence experiences and perceptions and factors associated with it. METHODS: A mixed-methods systematic review was conducted following the Joanna Briggs Institute guidelines for mixed-methods systematic reviews by including original qualitative and quantitative observational studies and mixed-methods studies published in English or Finnish between January 2012 and January 2024. The studies were retrieved from four databases (CINAHL, PubMed, Scopus, and Medic). In total, 4470 articles were screened, 122 were eligible for full-text screening, and 19 articles were included in the review according to the established inclusion and exclusion criteria. . Data tabulation and narrative synthesis for quantitative studies and content analysis for qualitative studies. RESULTS: The synthesis of qualitative data identified five main categories that describe healthcare leaders' experiences with digital competencies: (1) the need for developing leader's own, professionals', and patients' competence in the digitalisation of healthcare, (2) the need for expertise in the health IT implementation process, (3) positive perceptions towards technology, (4) negative perceptions towards technology, and (5) ability to act as an advocate to implement technology into practice. Data from the selected quantitative studies presents that factors associated with the digital competence of healthcare leaders include individual characteristics, career characteristics, training, and other factors. CONCLUSION: This review suggests that developing and supporting healthcare leaders' digital competencies should be considered in healthcare organizations, research, and education to make their digital competencies meet the demands of increasingly digitalising healthcare development work.