Transformational Leadership as a Driver of Staff Engagement and Retention in Healthcare: A Systematic Review

Background: Healthcare systems globally face significant challenges with staff turnover and disengagement. Transformational leadership (TL) has been identified as a potential strategy to improve workforce stability. This review synthesizes evidence on the impact of TL on staff engagement and retention in healthcare settings. Methods: A systematic review was conducted following PRISMA guidelines. A comprehensive search of PubMed, CINAHL, Scopus, and Web of Science identified peer-reviewed studies published between 2014 and 2024. Eight studies meeting the inclusion criteria were critically appraised using the Critical Appraisal Skills Programme (CASP) tool and analyzed thematically. Results: The findings consistently demonstrate that transformational leadership significantly enhances staff engagement by fostering empowerment, motivation, and a supportive work environment. Key TL behaviors—idealized influence, inspirational motivation, intellectual stimulation, and individualized consideration—were strongly correlated with increased job satisfaction and organizational commitment, leading to higher retention rates. Trust in leadership emerged as a critical mediating factor. Barriers to implementation included leadership inconsistency, resistance to change, and high workload pressures. Conclusion: Transformational leadership is a crucial determinant of staff engagement and retention in healthcare. Healthcare organizations should prioritize integrating structured TL training and development programs into leadership curricula. Fostering a supportive culture that emphasizes trust, recognition, and professional growth is essential for building a resilient and stable healthcare workforce.