Waluya The International Science Of Health Journal Vol.
5 No.
ISSN: 2829-2278
WALUYA THE INTERNATIONAL
SCIENCE OF HEALTH JOURNAL
The Influence of Transactional and Transformational Leadership Styles of Ward Heads on Patient Safety Culture Implementation in a Regional Hospital in Indonesia Muhammad Rafi1.
La Ode Saafi2.
Sartini Risky2 Benyamin Guluh Hospital.
Kolaka.
Indonesia Mandala Waluya University.
Indonesia Correspondence: muhammadrafi0117@gmail.
ARTICLE INFO
ABSTRACT
Article history Received : March 08th, 2026 Revised : March 17th, 2026 Accepted : March 30th, 2026 Introduction: Patient safety culture is an indicator of service quality and a system that makes patient care safer.
The leadership style of the head of the ward is one factor that influences the implementation of a patient safety culture.
Indonesia is still struggling to improve the quality of healthcare services by enhancing the patient safety culture among care professionals, including nurses.
This study aims to examine the influence of the Head of Room's transactional and transformational leadership style on the implementation of a patient safety culture in the Regional Public Service Agency.
Benyamin Guluh Hospital.
Kolaka Regency.
Keywords Leadership Style.
Patient Safety.
Method: Qantitative approach with a cross-sectional design was used, this study took place during July 2024.
Involving 140 respondents, consisting of team leaders and nurses working in inpatient care.
Result: The positive influence of transformational leadership style .
ositive directio.
T statistic 2.
665 and p-value 0.
and laizzes faire .
ositive directio.
T statistic 2.
828 and p-value 0.
in the implementation of patient safety Conclusion: This study emphasizes the importance of a ward head's leadership style that supports a patient safety culture, particularly in reporting individual performance indicators and implementing employee work targets.
It is recommended that hospitals improve the implementation of a patient safety culture by conducting continuous patient safety rounds, supervising, monitoring, and evaluating the implementation of individual performance indicators, and encouraging staff to report.
Introduction A culture of patient safety in a hospital is a collaborative environment where doctors respect DOI : https://doi.
org/10.
54883/1cf85v05 one another, leaders encourage effective teamwork and create a sense of psychological safety.
Team members can learn from patient safety incidents, https://ejournal.
id/wish/index Waluya The International Science Of Health Journal Vol.
5 No.
providers recognize that there are human limitations working in a complex system and there is a learning process and efforts to drive .
In addition, patient safety culture is an indicator of service quality and a system that makes patient care safer.
Patient safety culture is an integral part of health services.
This culture refers to the behavioral patterns of individuals and groups within an organization that prioritize patient safety above all else.
Healthcare has become complex, with the development of new therapeutic interventions and technologies.
These factors can have a negative impact on the level of healthcare services provided and patient safety, therefore, patient safety must be made a culture in hospitals.
The 2022 Ministry of Health Accreditation Standards, in the Hospital Governance chapter, standard 13, state that hospital management must demonstrate its commitment to promoting patient .
Improving Quality and Patient Safety Standard 10 patient safety culture measurements need to be carried out by hospitals, conducting a patient safety culture survey every year.
Hospital directors routinely evaluate the results of patient safety culture surveys by conducting analysis and follow-up.
Therefore, hospital leaders must be committed to implementing a patient safety .
The results of research related to the maturity of patient safety culture in hospitals in Indonesia are at the level of safety culture maturity of 708 hospitals is proactive, meaning that hospitals only achieved a score of 60% - <80% on 134 assessment elements of the First Edition of the National Hospital Accreditation Standards in maintaining quality and safety in hospitals.
Hospitals with a complete level were found to be at a proactive and generative level, meaning that accreditation surveys play a role in improving quality and safety in hospitals.
Meanwhile, the generative category of patient safety culture maturity at Makassar City Hospital was the most common choice, with 391 samples .
5%), and the reactive category was the least common, with 1 sample .
2%).
All three hospitals had a generative category of patient safety maturity.
Implementing a patient safety culture in healthcare can have both positive and negative A patient safety culture can contribute positively to organizational development.
Improving a culture of safety will help reduce costs to patients who suffer increased pain, disability, physical and psychological trauma, guilt, shame, loss of confidence and morale.
increase national targets, and reduce the need for additional care and additional beds.
14Meanwhile, the impact of indifference to patient safety results in losses for both patients and hospitals.
One of the top 10 causes of death and disability worldwide is due to unsafe care.
In high-income countries, an estimated one in 10 patients is harmed while receiving hospital care, of which nearly 50% is preventable, while in low- and middle-income countries 134 million experience adverse events due to unsafe care resulting in 2.
6 million deaths and four in 10 patients are harmed in primary and outpatient healthcare, of which 80% is .
The most common errors found that cause harm are related to the diagnosis, .
Additionally, preventable adverse events are estimated to range from 2% to 94%, with inappropriate prescribing being the most common type of adverse event.
Nurses play a crucial role in promoting and enhancing a culture of patient safety in hospitals.
As a developing country.
Indonesia continues to struggle to improve the quality of healthcare services by fostering a culture of patient safety among healthcare professionals, including .
Based on a review study conducted by Yodang identified several obstacles that inhibit nurses in Indonesia from promoting and improving a culture of patient safety, namely nurse organizational culture, support for equality and .
Furthermore, to overcome these obstacles, proposed several strategies to improve the promotion and implementation of a culture of patient safety, including the importance of education, including incorporating a culture of patient safety into the nursing curriculum, initiatives, and ongoing education.
Based on the description above, one of the inhibiting and supporting factors in the implementation of patient safety is leadership initiation.
Leadership style plays a crucial role in influencing how employees work.
Leadership is a creative, aspirational force, and a powerful moral Rafi et.
al (The Influence of Transactional and Transformational Leadership Styles of Ward Heads on Patient Safety Culture Implementation in a Regional Hospital in Indonesi.
Waluya The International Science Of Health Journal Vol.
5 No.
force that can influence members to change their attitudes so they align with the leader's desires.
One of the leadership styles that influences employee performance is transactional leadership .
Transformational leadership style, simultaneously and partially influence employee performance in the media service section.
An effective leadership style to improve patient safety is a transformational leadership style.
The leadership style of the room head according to Lippits and K.
White in Sugiharto namely authoritarian, democratic, and laissez-faire .
ree to Each leadership style has its advantages and .
A leader will use a leadership style that suits their abilities and personality.
Therefore, the head of the room as the person responsible for Quality Improvement and Patient Safety in the room plays a very important role in implementing a patient safety culture by reporting the achievement of quality indicators and Patient Safety Incidents every month to the Quality Committee.
The Quality Committee of the Benyamin Guluh Hospital Regional Public Service Agency is tasked with assisting the hospital Director in improvement, patient safety, and risk management at the hospital.
In carrying out its duties of improvement, the Quality Committee has the function of monitoring and guiding work units in selecting improvement priorities, measuring quality/quality indicators, and following up on the results of quality indicator achievements as well as implementing support for the implementation of a quality culture at the hospital.
styles on improving patient safety culture.
The research methodology adopted a quantitative approach with a cross-sectional design.
The study took place during July 2024, involving 140 respondents, consisting of team leaders and nurses working in inpatient care.
The use of multivariate Structural Equation Modeling and Partial Least Squares (PLS) tests enabled a comprehensive analysis of the influence of ward heads' leadership styles on improving patient safety culture.
Result Table 1 shows that respondents' answers regarding the leadership style of the room head vary from strongly disagree .
to strongly agree .
, in general respondents agree .
80%) that the room head has implemented a transactional leadership style, 47.
31% of respondents agree that the room head has implemented a transformational leadership style, 45.
55% of respondents agree that the room head has implemented a laizzes-faire leadership style and 43.
70% of respondents strongly disagree with the implementation of an authoritarian leadership style by the room head.
Table 2 shows that respondents who chose the transformational leadership style applied by the head of the room were 93 .
43%), the transactional leadership style was 27 .
29%), the laizzes-faire leadership style was 13 .
29%) and the least number of heads of the room applied the authoritarian leadership style, namely 7 .
0%).
Table 3 showed that the majority of nurses were compliant with Employee Work Targets implementation, namely 116 .
14%).
The implementation of Employee Work Targets 2 was the most compliant, namely 123 .
9%), and the least compliant was Employee Work Targets 5 .
4%).
This indicates that the role of ward heads in improving compliance with Employee Work Targetsimplementation still needs attention so that patient quality and safety are guaranteed.
Method This study was conducted at Benyamin Guluh Hospital in Kolaka Regency and aimed to examine the influence of ward heads' leadership Rafi et.
al (The Influence of Transactional and Transformational Leadership Styles of Ward Heads on Patient Safety Culture Implementation in a Regional Hospital in Indonesi.
Waluya The International Science Of Health Journal Vol.
5 No.
Table 1.
Distribution of Respondents According to Leadership Style Variables Based on Likert Scale Criteria Score Mean Score n (%) Answer Options Leadership Style Question Items Transformational .
GTF_1 GTF_2 GTF_3 GTF_4 GTF_5 GTF_6 GTF_7 GTF_8 GTF_9 GTF_10
GTF_11
GTF_12
Transactional .
GTK_1 GTK_2 GTK_3 GTK_4 Laizzes-Faire .
GLF_1 GLF_2 GLF_3 GLF_4 Authoritarian .
GKO_1 GKO_2 GKO_3 GKO_4 GKO_5 Don't agree n (%) Strongly Disagree n (%) Doubtful n (%) 5 .
25 ( 17.
Strongly n (%) Agree n (%) .
Table 2.
Distribution of Respondents According to Leadership Style Variables Leadership Style Transformational Transactional Laissez-Faire Authoritarian Yes Total Rafi et.
al (The Influence of Transactional and Transformational Leadership Styles of Ward Heads on Patient Safety Culture Implementation in a Regional Hospital in Indonesi.
Waluya The International Science Of Health Journal Vol.
5 No.
Table 3.
Distribution of Respondents According to the Variable of Patient Safety Culture Implementation Based on the Guttman Scale Score Answer Options Mean Score Item Not obey Obedient n (%) n (%) n (%) SKP 24 .
SKP_1
SKP_2
SKP_3
SKP_5
SKP_6
influence on the implementation of patient safety Thus, the hypothesis is rejected.
The results of this study align with previous research, which found no significant relationship between the implementation of management functions .
lanning and directin.
by ward heads.
The better the ward head's management functions, the better the nurses' implementation of patient .
Another study confirmed these findings, that the relationship between transactional leadership and patient safety perceptions was not significant ( = 0.
Other studies disagree with this study's findings, which suggest a significant relationship between transactional leadership style and the implementation of a patient safety culture and patient safety incidents .
ach with a p-value of 000 < 0.
The resulting relationship is moderate .
-value of 0.
30Ae0.
Other studies, however, suggest that improving leadership style and implementing a patient safety culture will reduce patient safety incidents.
Discussion Transactional leadership tends to involve transactions between leaders and subordinates, where the leader provides rewards when subordinates successfully complete tasks as Leaders and subordinates each have their own goals, needs, and interests.
Discriminant validity is a method of assessing how different a construct is from another construct, which can be determined by comparing the cross-loading values of the two constructs with the squared correlation value between the two constructs being tested.
The highest cross-loading value is 0.
The Transactional Leadership Style variable has a higher cross-loading indicator value for its own variable compared to other variables, so it is concluded that all of these variables meet the requirements of discriminant validity.
If someone perceives the results of a particular leadership style as positive, they will have a positive attitude toward that leadership Conversely, if a leadership style is perceived negatively, they will exhibit negative attitudes.
Thus, a ward manager's leadership style can have a positive or negative impact, or even no impact at all, on the implementation of a patient safety The test results of the path coefficient value of the transactional leadership style of the ward head on the implementation of patient safety culture are -0.
egative directio.
T statistics 004 and p-value 0.
This means that the T statistics value <1.
96 and p-value >0.
05, so that the control variable transactional leadership style of the ward head does not have a significant Conclusion This study emphasizes the importance of a ward head's leadership style that supports a patient safety culture, particularly in reporting Individual Performance Indicatorsand Employee Work Targets.
It is recommended that hospitals improve the implementation of a patient safety culture by conducting continuous patient safety rounds, supervising, monitoring, and evaluating the implementation of Employee Work Rafi et.
al (The Influence of Transactional and Transformational Leadership Styles of Ward Heads on Patient Safety Culture Implementation in a Regional Hospital in Indonesi.
Waluya The International Science Of Health Journal Vol.
5 No.
Targets, and encouraging staff to report Individual Performance Indicators.
The recommendations is expected to improve the culture of patient safety so that the care provided to patients is safe, the need for regular transformational leadership training and which will have an impact on improving the quality of services in hospitals.
inKaranganyar Regency.
Muhammadiyah Lecturer Assistant for Master of Hospital Administration 6, 35Ae49 .
Ratanto.
PATIENT
SAFETY
MANAGEMENT: Improving the Quality of Healthcare Services and Patient Safety.
(PT.
Sonpedia Publishing Indonesia, 2.
Natsir, a Overview of Patient Safety Culture at Haji Makassar Regional General Hospital in 2023.
Liana.
Lestari.
Sutoto.
Modjo.
Bachtiar.
A self-assessment model for hospital safety culture maturity.
Public Health Res.
11, jphr-2022 .
Reference