How transformational leadership relates to psychological safety and work engagement through decent work: Evidence from district headquarters hospitals in Punjab, Pakistan

Public hospitals in Punjab face high patient volumes, resource constraints, and administrative hierarchies that may influence employee behavior. This study examines the effects of transformational leadership on psychological safety and work engagement, considering perceived decent work as a partial mediator. Data were collected through a structured five-point Likert-scale questionnaire from 250 employees across five District Headquarters (DHQ) hospitals in Pakpattan, Rawalpindi, Bahawalpur, Sahiwal, and Murree. Data were analyzed using SmartPLS for partial least squares structural equation modeling (PLS-SEM), with 5,000 bootstrap resamples, and SPSS for descriptive statistics, reliability, correlation, regression, and mediation analysis. Composite reliability ranged from .878 to .887, while average variance extracted ranged from .509 to .567. Discriminant validity was supported by HTMT and Fornell–Larcker criteria. Transformational leadership significantly predicted decent work (β = .402, p < .001), psychological safety (β = .363, p < .001), and work engagement (β = .386, p < .001). Decent work significantly predicted psychological safety (β = .363, p < .001) and work engagement (β = .331, p < .001). It partially mediated both relationships, with indirect effects of .146 and .133 (both p < .001), accounting for approximately 29% and 26% of the total effects, respectively.