Transformational Leadership Impact on Speaking Up in Healthcare Teams

Speaking up for healthcare teams is essential in preventing incidents in healthcare settings as an existing survey study shows 41% of participants remained silent for at least one incident (Niederhauser & Schwappach 2022). Therefore, understanding the problem and formulation of strategies are essential. Transformational leadership fosters a psychologically safe environment for healthcare providers where they are more likely to speak up for patient safety. While hierarchy remains, leaders inspire, support, and encourage intellectual growth, making staff feel valued. However, evidence of its direct impact on speaking-up behavior is limited. This study is a systematic review of the literature applying the population, concept, and context (PCC) framework by examining healthcare teams as the population, transformational leadership’s role in communication as the concept, and hierarchical healthcare settings as the context, using key databases such as PubMed and ProQuest. Findings highlight two key themes: transformational leadership enhances communication by reducing power distance and fostering psychological safety, and common barriers to speaking up persist. These insights are crucial in healthcare, as reducing hierarchy and increasing psychological safety improve team collaboration and patient safety. Identifying barriers enables targeted strategies to enhance speaking-up behavior. However, gaps remain regarding long-term effects and cultural differences. Future research can include a longitudinal study to track psychological safety and communication changes over time, assessing leadership impact and in-depth interviews with healthcare professionals would provide qualitative insights into individual experiences and cultural influences. Combining these approaches would strengthen the understanding of the leadership role in fostering open communication.