Leadership and Organizational Climate in Hospitals: A Narrative Review of Mediators, Moderators, and Methodological Designs

Hospital organizational climate plays a particularly important role in healthcare institutions, given their labor-intensive nature. It correlates with staff satisfaction, retention, and well-being, as well as patient safety. Leadership, in turn, ranks among its most extensively studied antecedents. However, researchers have yet to synthesize the mechanisms underlying the relationship between these two constructs and the conditions that shape it within an integrated framework. This study aims to synthesize the evidence on the relationship between leadership styles and organizational climate in hospitals. The review examines the mediators, moderators, theoretical frameworks, and methodological designs employed to investigate this relationship. To achieve this objective, we conducted a narrative review of the literature indexed in Scopus. The findings indicate that transformational, supportive, participative, authentic, and servant leadership correlate with more favorable organizational climates. Conversely, laissez-faire, authoritarian, and toxic leadership associate with deteriorating organizational climates. Transactional leadership, however, yields mixed results. The most frequently reported mediators include communication, perceived organizational support, organizational justice, empowerment and autonomy, psychological safety, and burnout. Meanwhile, the moderators most frequently identified in the literature include organizational culture, unit-level subclimates, hospital size, resource availability, and hierarchical rigidity. Nevertheless, researchers have formally tested these moderating effects only in a limited number of studies. Cross-sectional, single-source designs predominate, with researchers relying primarily on regression analysis or structural equation modeling (SEM). Overall, the evidence supports an association between leadership and organizational climate, mediated by everyday working conditions and shaped by the hospital context. Further research should prioritize longitudinal and multilevel designs, explicit tests of moderation and moderated mediation, and empirical studies conducted in Latin American hospitals.