Articles
Open Access
Peer Reviewed
The Influence of Transformational Leadership on Occupational Safety Compliance: The Role of Organizational Culture and Competence in Hospital Settings
Abstract
Occupational safety compliance is a key concern in hospital settings, where operational complexity and high-risk exposure necessitate constant adherence to safety protocols. However, safety compliance is frequently viewed as a procedural requirement rather than a systemic organizational objective. The purpose of this study is to examine the combined impact of transformational leadership, organizational culture, and staff competency on occupational safety compliance in a hospital setting. A quantitative cross-sectional design was used, with 82 healthcare professionals recruited using total sampling. Data were examined using Partial Least Squares-Structural Equation Modeling (PLS-SEM) to assess both measurement and structural models. The results show that all constructs have appropriate validity and reliability, with outer loadings greater than 0.70. Transformational leadership, organizational culture, and competency account for 41% of variance in occupational safety compliance (R² = 0.41). Transformational leadership is the biggest predictor (β = 0.51, p < 0.001), with organizational culture and competence both having substantial positive impacts. According to these studies, leadership conduct, institutionalized safety ideals, and professional capacity all influence occupational safety compliance. The study indicates that sustainable occupational safety compliance in hospital settings cannot be achieved merely through regulatory enforcement, but requires integrated organizational strategies involving transformational leadership, safety-oriented organizational culture, and employee competence development.
References
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2. Naithani M, Khapre M, Kathrotia R, Gupta PK, Dhingra V, Rao S. Evaluation of Sensitization Program on Occupational Health Hazards for Nursing and Allied Health Care Workers in a Tertiary Health Care Setting. Frontiers in Public Health. 2021;9. https://doi.org/10.3389/fpubh.2021.669179.
3. Huei LC, Lin YW, Ming Y, Chen HL, Wang J, Hung LM. Occupational Health and Safety Hazards Faced by Healthcare Professionals in Taiwan: A Systematic Review of Risk Factors and Control Strategies. Sage Open Medicine. 2020;8. https://doi.org/10.1177/2050312120918999.
4. Dhahir NYAMDM. Assessment of Health Workers Knowledge Toward Occupational Health and Safety Program in Alkut City’s Primary Health Care Centers. Medico-Legal Update. 2021; https://doi.org/10.37506/mlu.v21i1.2540.
5. Asante K, Novák P. Predicting Nurses’ Safety Compliance Behaviour in a Developing Economy, Using the Theory of Planned Behaviour: A Configurational Approach. Journal of Advanced Nursing. 2023;80(3): 1097–1110. https://doi.org/10.1111/jan.15846.
6. Bowo EA, Ardhi MN, Yudisianto I, Muhammad BA. The Analysis of Occupational Health and Safety at the Muhammadiyah Lamongan Hospital. Journal of Multidisciplinary Science Mikailalsys. 2025;3(3): 1163–1180. https://doi.org/10.58578/mikailalsys.v3i3.7311.
7. Nazareth J, Kamath R, R VL, Somu G. An Exploratory Study on Adherence to Joint Commission International Standards on Facility Management and Safety at a Tertiary Care Hospital in Dubai, United Arab Emirates. Open Access Macedonian Journal of Medical Sciences. 2023;11(E): 271–275. https://doi.org/10.3889/oamjms.2023.10590.
8. Zgair LA, Khan Z, Makhbul ZKM, Atiqah N, Raflis A, Omar C. Occupational Safety Practices and Individual and Organizational Outcome: A Systematic Literature Review. Jurnal Pengurusan. 2023;67. https://doi.org/10.17576/pengurusan-2023-67-07.
9. Yılmaz A, Duygulu S. The Relationship Between Charge Nurses and Clinical Nurses’ Perceptions of Patient Safety Culture and Leadership Practices. Etkili Hemşirelik Dergisi. 2021;14(1): 29–37. https://doi.org/10.46483/deuhfed.743446.
10. Ystaas LMK, Nikitara M, Ghobrial S, Latzourakis E, Polychronis G, Constantinou CS. The Impact of Transformational Leadership in the Nursing Work Environment and Patients’ Outcomes: A Systematic Review. Nursing Reports. 2023;13(3): 1271–1290. https://doi.org/10.3390/nursrep13030108.
11. Linnik L, Sepp J, Reinhold K. Enhancing Patient Safety Through Leadership: A Comprehensive Literature Review on the Role of Head Nurses in Hospital Settings. Economics and Business. 2023;37(1): 220–235. https://doi.org/10.2478/eb-2023-0014.
12. Alanazi NH, Alshamlani Y, Baker OG. The Association Between Nurse Managers’ Transformational Leadership and Quality of Patient Care: A Systematic Review. International Nursing Review. 2022;70(2): 175–184. https://doi.org/10.1111/inr.12819.
13. Silvia V, Kusumapradja R, Jus’at I. The Role of Transformational Leadership and Effective Communication on the Implementation of Patient Safety With Trust as Mediation at X Hospital Jakarta. JMMR (Jurnal Medicoeticolegal Dan Manajemen Rumah Sakit). 2021;10(2): 90–102. https://doi.org/10.18196/jmmr.v10i2.10292.
14. Abdelaliem SMF, Alsenany SA. Factors Affecting Patient Safety Culture From Nurses’ Perspectives for Sustainable Nursing Practice. Healthcare. 2022;10(10): 1889. https://doi.org/10.3390/healthcare10101889.
15. Chang JG, Firebaugh RG, Jefferson CG. Integrating Standardized Patient Safety and Quality Competencies in Pharmacy Curriculum: Evaluation of the Impact on Student Development and Professional Identity. Jaccp Journal of the American College of Clinical Pharmacy. 2024;7(8): 809–823. https://doi.org/10.1002/jac5.2000.
16. Shin D, Lee YK, Song E, Kim J, Song R. Patient‐Centred Communication as a Mediator of Nurses’ Safety‐Care Activities. Scandinavian Journal of Caring Sciences. 2025;39(3). https://doi.org/10.1111/scs.70103.
17. Kopanz J, Lichtenegger KM, Schwarz C, Wimmer M, Kamolz L, Pieber TR, et al. Risks in the Analogue and Digitally-Supported Medication Process and Potential Solutions to Increase Patient Safety in the Hospital: A Mixed Methods Study. Plos One. 2024;19(2): e0297491. https://doi.org/10.1371/journal.pone.0297491.
18. Boloré S, Fassier T, Guirimand N. Effect of an Interprofessional Simulation Program on Patient Safety Competencies of Healthcare Professionals in Switzerland: A Before and After Study. Journal of Educational Evaluation for Health Professions. 2023;20: 25. https://doi.org/10.3352/jeehp.2023.20.25.
19. Ünal Ö. During COVID-19, Which Is More Effective in Work Accident Prevention Behavior of Healthcare Professionals: Safety Awareness or Fatalism Perception? Work a Journal of Prevention Assessment & Rehabilitation. 2020;67(4): 783–790. https://doi.org/10.3233/wor-203327.
20. Ip E, Srivastava R, Lentz L, Jasinoski S, Andérson GS. Antecedents of Workplace Psychological Safety in Public Safety and Frontline Healthcare: A Scoping Review. International Journal of Environmental Research and Public Health. 2025;22(6): 820. https://doi.org/10.3390/ijerph22060820.
21. Althobaiti FM. The Effects of Leadership on Patient Safety Culture in Health Care: A Systematic Review. BMC Nursing. 2026;25(1). https://doi.org/10.1186/s12912-025-04263-7.
22. Hamdan H, Mahmood R, Hashim RA, Rosli NS. Building a Safer Future: The Impact of Safety Leadership and Safety Competency in the Construction Industry. The Asian Journal of Professional & Business Studies. 2023;4(2). https://doi.org/10.61688/ajpbs.v4i2.124.
23. Sholihin M, Suswati E, Priyatna NM. The Role of Organizational Commitment in Mediating the Influence of Transformational Leadership and Organizational Culture on Employee Performance. Journal of Social Research. 2024;3(6): 1196–1208. https://doi.org/10.55324/josr.v3i6.1982.
24. Carlson MA, Morris S, Day F, Dadich A, Ryan A, Fradgley EA, et al. Psychometric Properties of Leadership Scales for Health Professionals: A Systematic Review. Implementation Science. 2021;16(1). https://doi.org/10.1186/s13012-021-01141-z.
25. Ree E. What Is the Role of Transformational Leadership, Work Environment and Patient Safety Culture for Person‐centred Care? A Cross‐sectional Study in Norwegian Nursing Homes and Home Care Services. Nursing Open. 2020;7(6): 1988–1996. https://doi.org/10.1002/nop2.592.
26. Berdida DJE, Grande RAN. Nurses’ Safety Climate, Quality of Care, and Standard Precautions Adherence and Compliance: A Cross‐sectional Study. Journal of Nursing Scholarship. 2024;56(3): 442–454. https://doi.org/10.1111/jnu.12960.
27. Heier L, Gambashidze N, Hammerschmidt J, Riouchi D, Weigl M, Neal A, et al. Safety Performance of Healthcare Professionals: Validation and Use of the Adapted Workplace Health and Safety Instrument. International Journal of Environmental Research and Public Health. 2021;18(15): 7816. https://doi.org/10.3390/ijerph18157816.
28. Hertanto A, Erwandi D, Widanarko B, Tejamaya M. Relationship Between Safety Climate and Safety Behavior in Company X in Indonesia. Safety. 2023;9(4): 89. https://doi.org/10.3390/safety9040089.
29. Miño-Terrancle J, Rubio JML, Pérez J, Sanchíz DC. Leadership and the Promotion of Health and Productivity in a Changing Environment: A Multiple Focus Groups Study. Safety. 2023;9(3): 45. https://doi.org/10.3390/safety9030045.
30. Li C, Murad M, Awais‐E‐Yazdan M. The Impact of Leadership Styles on Employee Safety Behaviour Among Chinese Healthcare Workers: The Moderating Role of Cooperation Facilitation. The International Journal of Health Planning and Management. 2023;38(5): 1377–1395. https://doi.org/10.1002/hpm.3666.
31. Ünal A, Yıldırım N, Öncel S. Investigation of the Relationship Between Perceived Leadership Behaviours of Nurses and Hospital Safety Culture: A Study With the Structural Equation Model. International Journal of Nursing Practice. 2025;31(1). https://doi.org/10.1111/ijn.13324.
32. Ahmed Z, Ellahham S, Soomro M, Shams S, Latif K. Exploring the Impact of Compassion and Leadership on Patient Safety and Quality in Healthcare Systems: A Narrative Review. BMJ Open Quality. 2024;13(Suppl 2): e002651. https://doi.org/10.1136/bmjoq-2023-002651.
33. Rizkia DG, Girsang AJ, Kusumapradja R, Hilmy M, Pamungkas RA, Dewi S. The Effect of Interprofessional Collaboration and Transformational Leadership on Patient Safety With Work Motivation as Intervening Variables. Riset. 2022;4(2): 39–53. https://doi.org/10.37641/riset.v4i2.156.
34. Badia E, Navajas J, Losilla JM. Safety Culture in the Spanish Nuclear Power Plants Through the Prism of High Reliability Organization, Resilience and Conflicting Objectives Theories. Applied Sciences. 2020;11(1): 345. https://doi.org/10.3390/app11010345.
35. Trinh MT, Feng Y. A Maturity Model for Resilient Safety Culture Development in Construction Companies. Buildings. 2022;12(6): 733. https://doi.org/10.3390/buildings12060733.
36. Hermanto B, Syahrul L, Yulihasri Y. The Influence of Organizational Culture, Work Environment, and Competence on Safety Health Occupation (SHO) Laboratory Employees With Safety Behavior as a Mediation Variable. Journal of Social Research. 2023;2(8): 2773–2789. https://doi.org/10.55324/josr.v2i8.1335.
37. Yao L, Zhao Q, Bai D, He S, Li Y, Xiao M, et al. Path Analysis of Factors Influencing Registered Nurses’ Safety Behavior in China: A Mediation Effect Model. Japan Journal of Nursing Science. 2025;22(1). https://doi.org/10.1111/jjns.12638.
38. Alanazi N, Falqi TA. Healthcare Managers’ Perception on Patient Safety Culture. Global Journal on Quality and Safety in Healthcare. 2023;6(1): 6–14. https://doi.org/10.36401/jqsh-22-13.
39. Smith CB, Purcell LN, Charles A. Cultural Competence, Safety, Humility, and Dexterity in Surgery. Current Surgery Reports. 2022;10(1): 1–7. https://doi.org/10.1007/s40137-021-00306-5.
40. Purvis R, Taylor N, Young M, James PA, Forrest L. Readiness and Leadership for the Implementation of Polygenic Risk Scores: Genetic Healthcare Providers’ Perspectives in the Hereditary Cancer Context. Journal of Genetic Counseling. 2025;34(4). https://doi.org/10.1002/jgc4.70084.
41. Dharmawan H, Ruswanti E, Kusumapradja R. The Effect of Leadership and Reward System on Patient Safety Culture Mediated by Nurses’ Motivation in Satya Negara Sunter Hospital. Jurnal Syntax Admiration. 2025;6(5): 31–38. https://doi.org/10.46799/jhs.v6i5.2548.
42. Nthumba P, Mwangi C, Osoo MO. Patient Safety in a Rural Sub-Saharan Africa Hospital: A 7-Year Experience at the AIC Kijabe Hospital, Kenya. Plos Global Public Health. 2024;4(11): e0003919. https://doi.org/10.1371/journal.pgph.0003919.
43. Din QMU, Li Z. Leadership Impact on Innovation: A Sequential Mediation of Trust and Safety. Work a Journal of Prevention Assessment & Rehabilitation. 2025; https://doi.org/10.1177/10519815251321952.
44. Hu X, Jiang L, Willis S, Casey T, Wu C. Paradoxical Safety Leadership: Conceptualization and Measurement. Journal of Organizational Behavior. 2024;46(1): 66–89. https://doi.org/10.1002/job.2826.
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