The Mediating Role of Knowledge Sharing in the Relationship Between Transformational Leadership, Organizational Culture, and Nursing Innovation in the Makkah Health Cluster

<ns5:p>Background Nursing innovation is essential for improving healthcare quality, patient safety, and organizational performance. Although transformational leadership and organizational culture have been recognized as important determinants of innovation, the mechanisms through which these organizational factors promote nursing innovation remain insufficiently understood. This study aimed to examine the effects of transformational leadership and organizational culture on nursing innovation, with knowledge sharing as a mediating variable among registered nurses working in the Makkah Health Cluster, Saudi Arabia. Methods A quantitative cross-sectional study was conducted among 531 registered nurses selected using stratified random sampling from six hospitals within the Makkah Health Cluster. Data were collected using standardized self-administered questionnaires measuring transformational leadership, organizational culture, knowledge sharing, and nursing innovation. Partial Least Squares Structural Equation Modeling (PLS-SEM) was employed to evaluate the measurement model, structural model, and mediating effects. Results Transformational leadership and organizational culture demonstrated significant positive effects on both knowledge sharing and nursing innovation. Knowledge sharing also exerted a significant positive effect on nursing innovation and partially mediated the relationships between transformational leadership and nursing innovation, as well as between organizational culture and nursing innovation. The structural model demonstrated satisfactory explanatory and predictive capability, indicating that leadership, organizational culture, and knowledge-sharing behaviours jointly contributed to nursing innovation. Conclusions Transformational leadership, supportive organizational culture, and effective knowledge sharing are complementary organizational resources that promote nursing innovation within integrated healthcare systems. Strengthening leadership capacity, fostering collaborative organizational cultures, and encouraging knowledge-sharing practices may enhance nursing innovation and support ongoing healthcare transformation initiatives under Saudi Vision 2030.</ns5:p>