ArticleJournal of healthcare leadership2026
Transformational Leadership, Work Engagement, and Patient Safety Culture in Public and Private Hospitals in Mogadishu, Somalia: A Study Protocol and Statistical Mediation Analysis.
Article in Journal of healthcare leadership, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Effective hospital leadership can influence workforce engagement, teamwork, communication, learning from error, and patient safety, but evidence from fragile and resource-constrained health systems remains limited. Objective: To present a study protocol for examining the association between transformational leadership and patient safety culture, and for testing healthcare workers' engagement as a statistical mediating (indirect) pathway between the two, in public and private hospitals in Mogadishu, Somalia. Methods: The protocol specifies a multicentre, institution-based analytical cross-sectional design with a target sample of 300 healthcare professionals selected through multistage stratified sampling, using a questionnaire that measures transformational leadership, work engagement, and ten dimensions of patient safety culture. To demonstrate the planned analytical workflow, this document also reports an illustrative analysis based on 300 computer-generated, synthetic responses; these figures are not empirical data collected from healthcare workers and are presented solely for methodological demonstration. Illustrative Results: In the synthetic dataset, the mean transformational leadership score was 3.09 (SD 0.84), work engagement was 3.38 (SD 1.38), and patient safety culture was 3.19 (SD 0.81). Leadership was correlated with engagement (r=0.420) and patient safety culture (r=0.465), and the illustrative indirect effect of leadership on patient safety culture through engagement was 0.137 (bootstrap 95% CI 0.089 to 0.187). Conclusion: The synthetic analysis demonstrates the proposed analytical workflow for interpreting leadership, engagement, and patient safety culture together. These figures are not empirical findings from Somali hospitals; substantive conclusions require implementation of the protocol with real participants.
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