The relationship between transformational leadership, high performance work system, organizational climate, and patient safety in Saudi public hospitals

This study examined the determinants of patient safety in public hospitals in Saudi Arabia. Specifically, it aimed to investigate the effect of transformational leadership, high
performance work system (HPWS), and effective reporting system on patient safety. This study also explored the mediating effect of organizational climate on the relationship between HPWS and patient safety. The motivation of this study was driven by lack of studies and inconsistent findings in the previous literature regarding the relationship between HPWS and patient safety. To achieve this purpose, this study integrated different
theories such as Donabedian theory (SPO), HROT theory, and transformational leadership theory to study the interaction between process and outcomes. The study utilized a survey questionnaire which was distributed to a sample of 182 public hospitals at 20 health regions in Saudi Arabia. PLS-SEM technique was used to analyze the direct and indirect relationships between the variables in this study. Result of this study found that transformational leadership had positively significant effect on HPWS and effective
reporting system. In addition, the result found that effective reporting system had significant effect on the frequency of occurrence of negative errors that may threaten
patient safety. This study also revealed that the level of organizational climate mediated the relationship between HPWS and overall perception of patient safety. The findings of this study suggest that managers and policy makers should emphasize developing transformational leadership style and ensuring the use of HPWS as an important
organizational strategy to improve patient safety. Finally, theoretical implications and recommendations for future research are highlighted and discussed.