Transformational Leadership and Knowledge on Patient Safety Culture: The Mediating Role of Organizational Commitment

Patient safety culture is a critical determinant of hospital service quality; however, its implementation in Indonesian regional public hospitals often remains challenging despite existing leadership capabilities and staff knowledge. This study examined the effects of transformational leadership and knowledge on patient safety culture, both directly and indirectly through organizational commitment as a mediating variable. A quantitative cross-sectional design was applied to all healthcare workers at RSUD Teluk Pucung, Bekasi City, with a population of 148 individuals. The sample was selected using total sampling, resulting in 147 valid respondents. Data were collected using an electronic questionnaire measuring transformational leadership, knowledge, organizational commitment, and patient safety culture. The data were analyzed using higher-order construct Partial Least Squares Structural Equation Modeling (PLS-SEM) with SmartPLS 4. The results showed that transformational leadership and knowledge had positive and significant effects on organizational commitment and patient safety culture, both directly and indirectly. Organizational commitment was found to partially mediate both relationships, with mediation proportions of 43.4% and 56.6%, respectively. The research model explained 56.1% of the variance in organizational commitment and 48.9% of the variance in patient safety culture. Further Importance–Performance Map Analysis (IPMA) indicated that affective commitment was the indicator with the highest intervention priority. These findings confirmed that strengthening patient safety culture requires simultaneous improvement in leadership, knowledge, and organizational commitment, with affective commitment serving as a primary managerial intervention focus.