The mediating role of knowledge transfer in the relationship between transformational leadership and digital healthcare performance in the Eastern Health Cluster, Saudi Arabia

Digital healthcare performance is a central objective of Saudi Arabia’s Vision 2030 reforms, particularly within the Eastern Health Cluster, where substantial investments in electronic health records, telemedicine, and other platforms require evidence of organisational impact. Transformational leadership and knowledge transfer are viewed as key drivers of digital performance, yet their combined effects remain under examined in integrated Gulf health systems. This study investigates whether knowledge transfer mediates the relationship between transformational leadership and digital healthcare performance in the Eastern Health Cluster, while accounting for change management practices. A quantitative cross-sectional survey was administered to employees across clinical, managerial, and digital roles using stratified random sampling (n = 402). A 40 item Likert scale instrument captured transformational leadership, change management, knowledge transfer, and digital healthcare performance. Partial least squares structural equation modelling with bootstrapping was used to assess the measurement and structural models and to test mediation. The model explained 37.7% of the variance in knowledge transfer (R² = 0.377) and 62.5% of the variance in digital healthcare performance (R² = 0.625). Transformational leadership and knowledge transfer both had significant positive paths to digital healthcare performance, and knowledge transfer partially mediated the leadership effect (indirect β = 0.181, p < 0.001; direct β = 0.321, p < 0.001). These findings position knowledge transfer as a critical conduit through which leadership behaviours shape digital outcomes and suggest that leadership development under Saudi digital health reforms should be coupled with deliberate knowledge management strategies in integrated care clusters.