The Impact of Healthcare Leadership on Patient-Centred Care: A Systematic Review

Abstract

Patient-centred care places patients’ preferences, needs, and values at the heart of clinical decisions and is recognised as essential for high-quality healthcare. Leadership is accepted as a critical influence on organisational culture and staff behaviour, yet the mechanisms through which leadership affects patient-centred care delivery and outcomes remain incompletely understood. This systematic review synthesised contemporary evidence on how healthcare leadership shapes the implementation and results of patient-centred care. The review was conducted and reported according to PRISMA 2020 guidelines. A PICO framework guided eligibility, and comprehensive searches were performed in PubMed and the Inflibnet ONOS portal for English-language studies published between 2016 and 2026. Two independent reviewers screened records in Rayyan, extracted data on leadership constructs, patient-centred outcomes, mechanisms, and limitations, and assessed quality using the Mixed Methods Appraisal Tool and SANRA checklist. Due to heterogeneity in study designs and measures, findings were synthesised narratively following SWiM guidance. Fourteen studies met inclusion criteria. Supportive leadership was consistently associated with improved patient-centred outcomes. Nurse managers’ leadership practices and positive staff perceptions correlated with higher patient satisfaction scores. Organisational leadership commitment, combined with culture change initiatives, produced statistically significant gains in HCAHPS-based patient experience across outpatient, emergency, and inpatient settings. Quality management practices under committed leadership predicted higher patient-centeredness scores. Qualitative evidence identified leadership support as a key facilitator, while poor communication between leaders and frontline staff and differing conceptualisations of patient-centred care emerged as important barriers. Transformational, compassionate, and emotionally intelligent leadership styles were linked to organisational cultures that promote patient engagement and safety. Most evidence originated from single-site or high-income settings, with limited causal or longitudinal data. Healthcare leadership is central to translating patient-centred values into everyday practice through culture shaping, staff support, and priority alignment. Health systems should prioritise leadership development programmes that build compassionate communication and sustained organisational commitment. Future research employing longitudinal and multi-site designs is needed to clarify causal mechanisms and identify effective interventions across diverse healthcare contexts.