Objective <p>This study explored hospital managers’ lived experiences with peer learning as a constructivist educational approach in healthcare management. It aimed to elucidate how peer learning contributes to managerial development and to identify contextual factors that either facilitate or hinder its effectiveness in healthcare organizations.</p> Results description <p>Peer learning significantly improved decision-making, managerial performance, inter-organizational interactions, and continuous updating of specialized knowledge. Exchanging real-world experiences enhanced critical thinking, professional attitudes, and self-efficacy among managers. Facilitating factors included strong organizational support, sharing successful practices, and benchmarking against high-performing hospitals. However, effectiveness was limited by weak teamwork culture, the absence of systematic management development strategies, restricted structured interactions, and organizational/structural barriers. Additional obstacles included limited managerial authority, deficiencies in succession planning, and inadequate coordination of directors’ assemblies by upstream institutions. Overall, peer learning proved highly valuable for developing managerial competencies, yet realizing its full potential requires eliminating structural obstacles and implementing targeted participatory policies and mechanisms (e.g., learning communities and succession planning programs).</p>