Transforming Care Through Leadership: A Mixed-Methods Synthesis of Evidence From the Philippines and the Global Health System

This study investigates the impact of healthcare leadership on patient, workforce, and organizational outcomes through a systematic review and mixed-methods synthesis of 50 empirical studies published between 2002 and 2025. The review includes 33 quantitative studies encompassing more than 100,000 patients and 45,000 nurses, alongside 17 qualitative and integrative reviews. Six studies were conducted in the Philippines, allowing for a direct comparison with 44 global studies. Quantitative findings demonstrated consistent associations between supportive leadership styles and improved outcomes. Transformational and authentic leadership were linked to lower hospital mortality (RR range 0.72–0.82), higher patient satisfaction (OR ≈1.35–1.50), and enhanced safety culture. Toxic and despotic leadership styles, by contrast, were strongly associated with nurse turnover intention in multiple contexts, including Ghana, Jordan, Egypt, and Iran. Qualitative synthesis, guided by the ENTREQ framework, identified five recurrent themes underpinning effective leadership: visibility and role modeling, accountability and governance, supportive organizational climate, professional development opportunities, and psychological safety. These themes were consistent across high-income and low- and middle-income settings, though Philippine studies highlighted ethical competence and managerial overload as distinctive contextual issues. The subgroup analysis confirmed that leadership exerts similar protective effects in the Philippines and globally, though policy relevance is heightened in migration-affected systems where nurse retention is critical. The findings underscore leadership as a life-saving intervention with direct effects on both patient survival and workforce sustainability. By integrating quantitative effect sizes with qualitative drivers, this review provides a comprehensive evidence base for policymakers and health system leaders. Leadership development and governance standards should be prioritized in national health strategies, accreditation frameworks, and workforce retention policies, particularly in countries experiencing health worker migration and resource constraints.本研究通过对2002年至2025年间发表的50项实证研究（empirical studies）开展系统综述（systematic review）与混合方法综合（mixed-methods synthesis），探讨了医疗照护领导力对患者结局、医护队伍绩效与组织绩效的影响。本次综述纳入33项定量研究，涵盖超10万名患者与4.5万名护士，同时纳入17项定性与整合性综述。其中6项研究在菲律宾开展，可与44项全球范围内的研究进行直接对照。 定量分析结果显示，支持型领导风格与绩效改善之间存在稳定关联。变革型领导（transformational leadership）与真实型领导（authentic leadership）分别与更低的医院死亡率（相对危险度RR区间为0.72~0.82）、更高的患者满意度（比值比OR≈1.35~1.50）以及更健全的安全文化显著相关。与之形成鲜明对比的是，破坏性与专制型领导风格在加纳、约旦、埃及、伊朗等多个场景中，均与护士离职意向（nurse turnover intention）存在强关联。 基于ENTREQ框架开展的定性综合分析，识别出支撑有效领导力的五大反复出现的核心主题：角色可见性与行为示范、问责制与治理、支持性组织氛围、专业发展机会以及心理安全（psychological safety）。上述主题在高收入与中低收入地区均具有普适性，但菲律宾的研究则凸显了伦理胜任力与管理过载作为独特的情境性问题。 亚组分析（subgroup analysis）证实，领导力在菲律宾与全球范围内均发挥相似的保护作用，但在护士留存至关重要的受移民影响的医疗体系中，其政策相关性更为显著。本研究结果凸显，领导力作为一项挽救生命的干预措施，可直接影响患者生存与医护队伍可持续性。 本综述将定量效应量与定性驱动因素相结合，为政策制定者与医疗体系领导者提供了全面的证据基础。国家卫生战略、认证框架以及医护队伍留存政策应优先考量领导力发展与治理标准，尤其是在面临卫生工作者迁移与资源受限的国家。