The effects of leadership on patient safety culture in health care: a systematic review

BACKGROUND: Nurse managers or leaders adopt transformational, transactional, servant, and ethical leadership styles. Nursing leadership styles shapes patient safety in healthcare organizations. Current literature is unclear on the link between leadership styles and patient safety in hospitals. The systematic review aimed to examine the effects of leadership on patient safety culture in health care. METHODS: Relevant literature was searched on PubMed, CINAHL, Cochrane Database of Systematic Reviews, ProQuest-Nursing & Allied Health, PsycINFO, and Scopus with keywords and search terms. Eligibility criteria covered studies addressing the research question, containing primary studies, written in English, and published between 2008 and 2024. PRISMA 2020 Framework was used in the screening process and data extraction conducted. FINDINGS: Out of the 507 studies found in the databases, studies (n = 12) that met the eligibility criteria were included. Quality appraisal of the studies showed low risk of bias and hence their inclusion for narrative synthesis. Data extracted and subsequent narrative synthesis found that transformational leadership, ethical leadership, and transactional leadership styles, which impacted patient safety culture positively improved teamwork, positive manager expectations, organizational learning, feedback, communication, and positive perceptions on safety. Leadership factors affecting patient safety culture were nurses' organizational commitment, education or training, job recourses, work engagement, and mentorship for enhancing nurses' competence. CONCLUSION: The systematic review confirmed that leadership style creates patient safety culture. Future studies should examine the long-term impacts of varied leadership styles particularly transformational and ethical leadership style on patient safety in different healthcare settings.