Effects of Transformational, Transactional, and Servant Leadership on Employee Performance in Hospitals Operated by the Ministry of National Guard–Health Affairs, Saudi Arabia: The Mediating Role of Organizational Identification

Abstract

This study examined the relationships of transformational, transactional, and servant leadership with self-reported employee performance in five hospitals operated by the Ministry of National Guard–Health Affairs (MNG-HA), Saudi Arabia, and evaluated organizational identification as a mediator. A quantitative cross-sectional survey used stratified random sampling administered by hospital Human Resources departments. Of 960 invited employees, 515 questionnaire records were received and 500 valid responses were retained, yielding an invitation-based valid response rate of 52.1%. IBM SPSS Statistics version 28 and SmartPLS 4 were used to evaluate five reflective constructs and their direct and specific indirect relationships. Transformational (β = .314), transactional (β = .286), and servant leadership (β = .244) were positively associated with organizational identification (all p < .001). Employee performance was positively associated with organizational identification (β = .313) and transactional (β = .362), servant (β = .154), and transformational leadership (β = .146), all p < .001. The model explained 39.1% of organizational-identification variance and 55.3% of employee-performance variance. Specific indirect effects were significant for transformational (β = .098), transactional (β = .090), and servant leadership (β = .076), with corresponding variance-accounted-for values of 40.1%, 19.9%, and 33.1%. Positive direct and indirect effects indicated complementary partial mediation. The original-scale and z-standardized models yielded the same standardized conclusions. The findings clarify the complementary roles of the three leadership approaches: transactional leadership had the largest estimated direct association with performance, transformational leadership had the largest estimated association with organizational identification, and servant leadership contributed positively to both outcomes. Their simultaneous examination provides empirical support for Social Identity Theory in a multiprofessional Saudi healthcare setting and identifies organizational identification as a shared psychological pathway connecting leadership with performance. This integrated evidence informs leadership development that combines performance clarity, shared organizational purpose, and employee support within MNG-HA hospitals.