Leadership Styles and Safety Performance Among Employees in Healthcare Facilities: A Systematic Review



M Jafari Nodoushan MAHDI ; A Houshang Mehrparvar AMIR ; Ma Ghoveh Nodoushan Mohammad ALI ; Rj Nodoushan Reza JAFARI ; A Karimi ALI
Source: Journal of Health and Safety at Work Published:2025

Abstract

Introduction: Safety in healthcare facilities is critically important for the health and well-being of employees, patients, and organizational effectiveness. In recent years, various studies have examined the relationship between leadership styles or approaches and safety performance as one of the indicators of safety promotion. The present systematic review examines the relationship between different leadership styles and the safety performance of employees in healthcare facilities to provide a better understanding of the positive or negative effects of leadership on safety and to suggest strategies for improving safety performance in healthcare facilities. Material and Methods: A search was conducted in Scopus, PubMed, and Web of Science (ISI) databases. Keywords related to leadership, safety performance, and healthcare employees were used. Studies published up to the end of 2024 were identified and reviewed in accordance with PRISMA guidelines. Results: Nineteen relevant papers were selected and included in the study. During the review of studies, eleven leadership styles or approaches were identified in relation to safety performance in various healthcare facilities. These included transformational leadership, leader-member exchange leadership, leader safety priority communication and feedback, ethical leadership, empowering leadership, inconsistent and destructive leadership, transactional leadership, task-oriented leadership, authentic leadership, safety leadership, and servant leadership. All leadership styles except for inconsistent and destructive leadership had a direct or indirect positive effect on safety performance. Also, the largest number of studies (n=4) focused on transformational leadership style and leader-member exchange leadership. Conclusion: The selection of appropriate leadership styles can contribute to enhanced safety, a reduction in occupational incidents, and improving service quality in healthcare settings. The findings of this study highlight the importance of developing effective leadership styles and strengthening appropriate managerial approaches to improve safety in healthcare facilities. © 2025 Elsevier B.V., All rights reserved.