The Role of Safety Culture, Clinical Leadership Capacity, and Teamwork

https://doi.org/10.35912/gabs.v2i3.3872
Published: Jan 30, 2026

Abstract:

Purpose: This study aims to examine the effects of patient safety culture and clinical leadership capacity on nurses’ incident reporting compliance, with teamwork tested as a mediating mechanism.

Research methodology: A census survey was conducted among 204 nurses at Sentra Medika Hospital Cikarang. Data were collected using a structured questionnaire comprising 18 validated indicators and analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM).

Results: The results indicate that patient safety culture has a significant positive effect on both incident reporting compliance and teamwork. Clinical leadership capacity also demonstrates significant positive effects on teamwork and reporting compliance. Notably, teamwork shows a significant negative direct effect on incident reporting compliance, suggesting a preference for informal, team-based problem resolution that may substitute for formal reporting processes. However, teamwork significantly mediates the relationships between patient safety culture, clinical leadership capacity, and reporting compliance.

Conclusions: The findings highlight a paradoxical role of teamwork in patient safety. While collaborative environments are essential, they must be strategically aligned with non-punitive and transparent reporting systems. Strengthening patient safety culture and clinical leadership, while institutionalizing team practices that reinforce formal reporting, is essential to enhance sustainable patient safety performance.

Limitations: The study is limited to a specific hospital setting and may not be generalizable to all healthcare environments. Additionally, the study relies on self-reported data, which may introduce bias.

Contributions: This study contributes to the understanding of how patient safety culture, clinical leadership capacity, and teamwork interact to influence incident reporting compliance in hospitals, emphasizing the need for a balanced approach that integrates both formal reporting systems and collaborative team practices.

Keywords:
1. Clinical Leadership
2. Incident Reporting
3. Patient Safety Culture
4. Teamwork
Authors:
1 . Rika Rika
Universitas Kristen Krida Wacana, Jakarta
2 . Hery Winoto Tj
Universitas Kristen Krida Wacana, Jakarta
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How to Cite
Rika, R., & Tj, H. W. . (2026). The Role of Safety Culture, Clinical Leadership Capacity, and Teamwork. Global Academy of Business Studies, 2(3), 185–202. https://doi.org/10.35912/gabs.v2i3.3872
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Issue & Section
Vol. 2 No. 3 (2026): January
Articles
References

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    Alabdullah, H., & Karwowski, W. (2024). Patient safety culture in hospital settings across continents: a systematic review. Applied Sciences, 14(18), 8496. doi:https://doi.org/10.3390/app14188496

    Alanazi, F. K., Lapkin, S., Molloy, L., & Sim, J. (2023). Safety culture, quality of care, missed care, nurse staffing and their impact on pressure injuries: A cross-sectional multi-source study. International Journal of Nursing Studies Advances, 5, 100125. doi:https://doi.org/10.1016/j.ijnsa.2023.100125

    Alsobou, N., Rayan, A. H., Baqeas, M. H., ALBashtawy, M. S. d., Oweidat, I. A., Al-Mugheed, K., & Abdelaliem, S. M. F. (2025). The relationship between patient safety culture and attitudes toward incident reporting among registered nurses. BMC health services research, 25(1), 612. doi:https://doi.org/10.1186/s12913-025-12763-0

    Arzani, S., Amerzadeh, M., Alizadeh, A., Moosavi, S., & Kalhor, R. (2025). The mediating role of job burnout in the relationship between career plateau and turnover intention among nurses. Scientific Reports, 15(1), 35508. doi:https://doi.org/10.1038/s41598-025-19518-1

    Beecham, E., Brady, G., Iqbal, S., Fatima, Q., Arshad, S., Bondaronek, P., & Gilchrist, K. (2025). Systematic review of patient safety incident reporting practices in maternity care. BMJ Open Quality, 14(4), 1-15. doi:https://doi.org/10.1136/bmjoq-2025-003432

    Berglund, L., Johansson, J., Johansson, M., Nygren, M., & Stenberg, M. (2025). Structures and Processes for Safety Culture? Perspectives from Safety Leaders in the Swedish Construction Industry. Safety, 11(2), 47. doi:https://doi.org/10.3390/safety11020047

    Chiang, H. Y., Lee, H. F., Lin, S. Y., & Ma, S. C. (2019). Factors contributing to voluntariness of incident reporting among hospital nurses. Journal of nursing management, 27(4), 806-814. doi:https://doi.org/10.1111/jonm.12744

    Chilukuri, G., & Westerman, S. T. (2024). Healthcare Workers’ Perceptions of Patient Safety Culture in United States Hospitals: A Systematic Review and Meta-Analysis. International Journal of Medical Students, 12(4), 422-436. doi:https://doi.org/10.5195/ijms.2024.2560

    Dera, A. K., Adedokun, M. W., & Iyiola, K. (2025). The Psychosocial Safety Climate’s Influence on Safety Behavior and Employee Engagement: Does Safety Leadership Really Count? Behavioral Sciences, 15(2), 179. doi:https://doi.org/10.3390/bs15020179

    Desty, M. (2025). An examination of safety culture in patient safety incident reporting: a literature review through the spider framework. International Journal of Research in Business & Social Science, 14(3), 418-421. doi:https://doi.org/10.20525/ijrbs.v14i3.3981

    Dhamanti, I., Rachman, T., Sholikhah, V. H., & Tjahjono, B. (2025). Exploring healthcare workers’ experience and barriers in disclosing patient safety-related incidents: A qualitative study in Indonesian hospitals. International Journal of Healthcare Management, 18(4), 686-694. doi:https://doi.org/10.1080/20479700.2024.2358709

    Edmondson, A. C. (2018). The fearless organization: Creating psychological safety in the workplace for learning, innovation, and growth: John Wiley & Sons.

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    Elmi, A. H., Hassan, R. A., Abdi, A. O., Yusuf, F. Y., HassanIbrahim, K., & Abdi, A. A. (2025). Awareness of reporting practices and barriers to incident reporting among nurses in Mogadishu, Somalia. BMC nursing, 24(1), 1134. doi:https://doi.org/10.1186/s12912-025-03799-y

    Elseesy, N. A. M., Almezraq, B. A., Hafez, D. A., Felemban, O., & Felemban, E. M. (2025). Breaking the Silence: Barriers to Error Disclosure Among Nurses in the Kingdom of Saudi Arabia—A Cross-Sectional Study. Paper presented at the Healthcare.

    Fekadu, G., Muir, R., Tobiano, G., Ireland, M. J., Engidaw, M. T., & Marshall, A. P. (2025). Patient safety incident reporting systems and reporting practices in African healthcare organisations: a systematic review and meta-analysis. BMJ Open Quality, 14(1). doi:https://doi.org/10.1136/bmjoq-2024-003202

    Garay, S., Haeger, M., Kühnlein, L., Sulmann, D., & Suhr, R. (2023). Interventions to enhance safety culture for nursing professionals in long-term care: A systematic review. International Journal of Nursing Studies Advances, 5, 100119. doi:https://doi.org/10.1016/j.ijnsa.2023.100119

    Gemeda, S. N., & Kibret, A. (2025). Patient Safety Incident Reporting Behaviour and Associated Factors Among Nurses Working in Public Hospitals in Addis Ababa, Ethiopia (2024). Journal of BioMed Research and Reports, 8(1), 1-13. doi:https://doi.org/10.59657/2837-4681.brs.25.168

    Guo, Y. F., Fan, J. Y., Lam, L., Plummer, V., Cross, W., Ma, Y. Z., & Jia, Y. N. (2022). Associations between perceived overqualification, transformational leadership and burnout in nurses from intensive care units: A multicentre survey. Journal of nursing management, 30(7), 3330-3339. doi:https://doi.org/10.1111/jonm.13774

    Hajizadeh, A., Amini Kordkandi, B., Sadeghpour, S., Khodavandi, M., Saeidpour, J., & Kakemam, E. (2025). Nurses’ perception of patient safety culture using the Hospital Survey on Patient Safety Culture tool and its association with nursing-patient outcomes: a systematic review in Iranian hospitals. BMC nursing, 24(1), 774. doi:https://doi.org/10.1186/s12912-025-03305-4

    Javed, B., Naqvi, S. M. M. R., Khan, A. K., Arjoon, S., & Tayyeb, H. H. (2019). Impact of inclusive leadership on innovative work behavior: The role of psychological safety. Journal of Management & Organization, 25(1), 117-136. doi:https://doi.org/10.1017/jmo.2017.3

    Lawati, M. H. A., Dennis, S., Short, S. D., & Abdulhadi, N. N. (2018). Patient safety and safety culture in primary health care: a systematic review. BMC family practice, 19(1), 104. doi:https://doi.org/10.1186/s12875-018-0793-7

    Lee, J., Nam, K. h., Suh, Y., Lee, Y., & Lee, D. (2025). Factors Associated With Patient Safety Activities of Clinical Nurses: A Cross?Sectional Secondary Data Analysis. International Nursing Review, 72(4), 1-10. doi:https://doi.org/10.1111/inr.70127

    Lonatrista, M. A., & Tj, H. W. (2025). Workplace training mediates safety culture towards patient safety. Global Academy of Business Studies, 2(2), 101-116. doi:https://doi.org/10.35912/gabs.v2i2.3609

    Martins, T., Bellagamba, D., Simon, M., Bucher Andary, J., & Zúñiga, F. (2025). Patient safety culture in home care and its related factors and outcomes: a scoping review. BMC health services research, 25(1), 1531.

    Meneses-La-Riva, M. E., Fernández-Bedoya, V. H., Suyo-Vega, J. A., Ocupa-Cabrera, H. G., Grijalva-Salazar, R. V., & Ocupa-Meneses, G. d. D. (2025). Enhancing Healthcare Efficiency: The Relationship Between Effective Communication and Teamwork Among Nurses in Peru. Nursing Reports, 15(2), 59. doi:https://doi.org/10.3390/nursrep15020059

    Mrayyan, M. T., Algunmeeyn, A., Abunab, H. Y., Kutah, O. A., Alfayoumi, I., & Khait, A. A. (2023). Attributes, skills and actions of clinical leadership in nursing as reported by hospital nurses: a cross-sectional study. BMJ leader, 7(3), 1-9. doi:https://doi.org/10.1136/leader-2022-000672

    Nugroho, S. H., Said, M., & Said, L. R. (2025). The effect of work environment, compensation, career development, leadership, and workload on job satisfaction with work motivation as an intervening variable. Annals of Human Resource Management Research, 5(3), 13-35. doi:https://doi.org/10.35912/ahrmr.v5i3.2826

    Pamela, C. A., Ahsan, A., & Wardhani, V. (2025). Relationship between head nurses' transformational leadership style and attitudes toward reporting patient safety incidents in Hospitals. JNKI (Jurnal Ners dan Kebidanan Indonesia)(Indonesian Journal of Nursing and Midwifery), 13(2), 213-225. doi:https://doi.org/10.21927/jnki.2025.13(2).213-225

    Putra, K. R., Hany, A., Ningrum, E., Arisetijono, E., Taji, M., & Vatmasari, R. (2025). Patient Safety Culture, Missed Nursing Care, and Adverse Events in University Hospitals: A Cross-Sectional Study. Iranian Journal of Nursing and Midwifery Research, 30(3), 349-355. doi:https://doi.org/10.4103/ijnmr.ijnmr_210_23

    Shameela, A., & Sulistiadi, W. (2024). The Role of Teamwork in Building Patient Safety Culture at Hospital “X” in South Jakarta, Indonesia. International Journal of Nursing and Health Services (IJNHS), 7(1), 387-394. doi:https://doi.org/10.35654/ijnhs.v7i1.765

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    WHO. (2020). Patient safety incident reporting and learning systems: technical report and guidance.

    Yilmaz, A., Yildiz Keskin, A., & Sönmez, B. (2025). Nurses' Perceptions of Patient Safety Culture and Voice Behaviors: A Descriptive and Correlational Study. Journal of Evaluation in Clinical Practice, 31(3), 1-12. doi:https://doi.org/10.1111/jep.70046

    Zadow, A. J., Dollard, M. F., Dormann, C., & Landsbergis, P. (2021). Predicting new major depression symptoms from long working hours, psychosocial safety climate and work engagement: a population-based cohort study. BMJ open, 11(6), 1-14. doi:https://doi.org/10.1136/bmjopen-2020-044133

    Zarandona, J., Labaka, A., Unanue?Arza, S., & Lapkin, S. (2025). Nursing Students' Behavioral Intentions Toward Medication Safety: A Cross?Sectional Study Based on the Theory of Planned Behavior. Nursing & health sciences, 27(4), 1-12. doi:https://doi.org/10.1111/nhs.70258

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  2. Alabdullah, H., & Karwowski, W. (2024). Patient safety culture in hospital settings across continents: a systematic review. Applied Sciences, 14(18), 8496. doi:https://doi.org/10.3390/app14188496
  3. Alanazi, F. K., Lapkin, S., Molloy, L., & Sim, J. (2023). Safety culture, quality of care, missed care, nurse staffing and their impact on pressure injuries: A cross-sectional multi-source study. International Journal of Nursing Studies Advances, 5, 100125. doi:https://doi.org/10.1016/j.ijnsa.2023.100125
  4. Alsobou, N., Rayan, A. H., Baqeas, M. H., ALBashtawy, M. S. d., Oweidat, I. A., Al-Mugheed, K., & Abdelaliem, S. M. F. (2025). The relationship between patient safety culture and attitudes toward incident reporting among registered nurses. BMC health services research, 25(1), 612. doi:https://doi.org/10.1186/s12913-025-12763-0
  5. Arzani, S., Amerzadeh, M., Alizadeh, A., Moosavi, S., & Kalhor, R. (2025). The mediating role of job burnout in the relationship between career plateau and turnover intention among nurses. Scientific Reports, 15(1), 35508. doi:https://doi.org/10.1038/s41598-025-19518-1
  6. Beecham, E., Brady, G., Iqbal, S., Fatima, Q., Arshad, S., Bondaronek, P., & Gilchrist, K. (2025). Systematic review of patient safety incident reporting practices in maternity care. BMJ Open Quality, 14(4), 1-15. doi:https://doi.org/10.1136/bmjoq-2025-003432
  7. Berglund, L., Johansson, J., Johansson, M., Nygren, M., & Stenberg, M. (2025). Structures and Processes for Safety Culture? Perspectives from Safety Leaders in the Swedish Construction Industry. Safety, 11(2), 47. doi:https://doi.org/10.3390/safety11020047
  8. Chiang, H. Y., Lee, H. F., Lin, S. Y., & Ma, S. C. (2019). Factors contributing to voluntariness of incident reporting among hospital nurses. Journal of nursing management, 27(4), 806-814. doi:https://doi.org/10.1111/jonm.12744
  9. Chilukuri, G., & Westerman, S. T. (2024). Healthcare Workers’ Perceptions of Patient Safety Culture in United States Hospitals: A Systematic Review and Meta-Analysis. International Journal of Medical Students, 12(4), 422-436. doi:https://doi.org/10.5195/ijms.2024.2560
  10. Dera, A. K., Adedokun, M. W., & Iyiola, K. (2025). The Psychosocial Safety Climate’s Influence on Safety Behavior and Employee Engagement: Does Safety Leadership Really Count? Behavioral Sciences, 15(2), 179. doi:https://doi.org/10.3390/bs15020179
  11. Desty, M. (2025). An examination of safety culture in patient safety incident reporting: a literature review through the spider framework. International Journal of Research in Business & Social Science, 14(3), 418-421. doi:https://doi.org/10.20525/ijrbs.v14i3.3981
  12. Dhamanti, I., Rachman, T., Sholikhah, V. H., & Tjahjono, B. (2025). Exploring healthcare workers’ experience and barriers in disclosing patient safety-related incidents: A qualitative study in Indonesian hospitals. International Journal of Healthcare Management, 18(4), 686-694. doi:https://doi.org/10.1080/20479700.2024.2358709
  13. Edmondson, A. C. (2018). The fearless organization: Creating psychological safety in the workplace for learning, innovation, and growth: John Wiley & Sons.
  14. El-Sayed, B. K. M., Mohmed, E. A. T., Baddar, F. M., & Khattab, S. M. K. (2025). Insights from critical care nurses: role of leadership coaching in enhancing incident reporting culture: a cross-sectional study. BMC nursing, 24(1), 1156. doi:https://doi.org/10.1186/s12912-025-03791-6
  15. Elmi, A. H., Hassan, R. A., Abdi, A. O., Yusuf, F. Y., HassanIbrahim, K., & Abdi, A. A. (2025). Awareness of reporting practices and barriers to incident reporting among nurses in Mogadishu, Somalia. BMC nursing, 24(1), 1134. doi:https://doi.org/10.1186/s12912-025-03799-y
  16. Elseesy, N. A. M., Almezraq, B. A., Hafez, D. A., Felemban, O., & Felemban, E. M. (2025). Breaking the Silence: Barriers to Error Disclosure Among Nurses in the Kingdom of Saudi Arabia—A Cross-Sectional Study. Paper presented at the Healthcare.
  17. Fekadu, G., Muir, R., Tobiano, G., Ireland, M. J., Engidaw, M. T., & Marshall, A. P. (2025). Patient safety incident reporting systems and reporting practices in African healthcare organisations: a systematic review and meta-analysis. BMJ Open Quality, 14(1). doi:https://doi.org/10.1136/bmjoq-2024-003202
  18. Garay, S., Haeger, M., Kühnlein, L., Sulmann, D., & Suhr, R. (2023). Interventions to enhance safety culture for nursing professionals in long-term care: A systematic review. International Journal of Nursing Studies Advances, 5, 100119. doi:https://doi.org/10.1016/j.ijnsa.2023.100119
  19. Gemeda, S. N., & Kibret, A. (2025). Patient Safety Incident Reporting Behaviour and Associated Factors Among Nurses Working in Public Hospitals in Addis Ababa, Ethiopia (2024). Journal of BioMed Research and Reports, 8(1), 1-13. doi:https://doi.org/10.59657/2837-4681.brs.25.168
  20. Guo, Y. F., Fan, J. Y., Lam, L., Plummer, V., Cross, W., Ma, Y. Z., & Jia, Y. N. (2022). Associations between perceived overqualification, transformational leadership and burnout in nurses from intensive care units: A multicentre survey. Journal of nursing management, 30(7), 3330-3339. doi:https://doi.org/10.1111/jonm.13774
  21. Hajizadeh, A., Amini Kordkandi, B., Sadeghpour, S., Khodavandi, M., Saeidpour, J., & Kakemam, E. (2025). Nurses’ perception of patient safety culture using the Hospital Survey on Patient Safety Culture tool and its association with nursing-patient outcomes: a systematic review in Iranian hospitals. BMC nursing, 24(1), 774. doi:https://doi.org/10.1186/s12912-025-03305-4
  22. Javed, B., Naqvi, S. M. M. R., Khan, A. K., Arjoon, S., & Tayyeb, H. H. (2019). Impact of inclusive leadership on innovative work behavior: The role of psychological safety. Journal of Management & Organization, 25(1), 117-136. doi:https://doi.org/10.1017/jmo.2017.3
  23. Lawati, M. H. A., Dennis, S., Short, S. D., & Abdulhadi, N. N. (2018). Patient safety and safety culture in primary health care: a systematic review. BMC family practice, 19(1), 104. doi:https://doi.org/10.1186/s12875-018-0793-7
  24. Lee, J., Nam, K. h., Suh, Y., Lee, Y., & Lee, D. (2025). Factors Associated With Patient Safety Activities of Clinical Nurses: A Cross?Sectional Secondary Data Analysis. International Nursing Review, 72(4), 1-10. doi:https://doi.org/10.1111/inr.70127
  25. Lonatrista, M. A., & Tj, H. W. (2025). Workplace training mediates safety culture towards patient safety. Global Academy of Business Studies, 2(2), 101-116. doi:https://doi.org/10.35912/gabs.v2i2.3609
  26. Martins, T., Bellagamba, D., Simon, M., Bucher Andary, J., & Zúñiga, F. (2025). Patient safety culture in home care and its related factors and outcomes: a scoping review. BMC health services research, 25(1), 1531.
  27. Meneses-La-Riva, M. E., Fernández-Bedoya, V. H., Suyo-Vega, J. A., Ocupa-Cabrera, H. G., Grijalva-Salazar, R. V., & Ocupa-Meneses, G. d. D. (2025). Enhancing Healthcare Efficiency: The Relationship Between Effective Communication and Teamwork Among Nurses in Peru. Nursing Reports, 15(2), 59. doi:https://doi.org/10.3390/nursrep15020059
  28. Mrayyan, M. T., Algunmeeyn, A., Abunab, H. Y., Kutah, O. A., Alfayoumi, I., & Khait, A. A. (2023). Attributes, skills and actions of clinical leadership in nursing as reported by hospital nurses: a cross-sectional study. BMJ leader, 7(3), 1-9. doi:https://doi.org/10.1136/leader-2022-000672
  29. Nugroho, S. H., Said, M., & Said, L. R. (2025). The effect of work environment, compensation, career development, leadership, and workload on job satisfaction with work motivation as an intervening variable. Annals of Human Resource Management Research, 5(3), 13-35. doi:https://doi.org/10.35912/ahrmr.v5i3.2826
  30. Pamela, C. A., Ahsan, A., & Wardhani, V. (2025). Relationship between head nurses' transformational leadership style and attitudes toward reporting patient safety incidents in Hospitals. JNKI (Jurnal Ners dan Kebidanan Indonesia)(Indonesian Journal of Nursing and Midwifery), 13(2), 213-225. doi:https://doi.org/10.21927/jnki.2025.13(2).213-225
  31. Putra, K. R., Hany, A., Ningrum, E., Arisetijono, E., Taji, M., & Vatmasari, R. (2025). Patient Safety Culture, Missed Nursing Care, and Adverse Events in University Hospitals: A Cross-Sectional Study. Iranian Journal of Nursing and Midwifery Research, 30(3), 349-355. doi:https://doi.org/10.4103/ijnmr.ijnmr_210_23
  32. Shameela, A., & Sulistiadi, W. (2024). The Role of Teamwork in Building Patient Safety Culture at Hospital “X” in South Jakarta, Indonesia. International Journal of Nursing and Health Services (IJNHS), 7(1), 387-394. doi:https://doi.org/10.35654/ijnhs.v7i1.765
  33. Stanley, D., & Stanley, K. (2018). Clinical leadership and nursing explored: A literature search. Journal of clinical nursing, 27(9-10), 1730-1743. doi:https://doi.org/10.1111/jocn.14145
  34. WHO. (2020). Patient safety incident reporting and learning systems: technical report and guidance.
  35. Yilmaz, A., Yildiz Keskin, A., & Sönmez, B. (2025). Nurses' Perceptions of Patient Safety Culture and Voice Behaviors: A Descriptive and Correlational Study. Journal of Evaluation in Clinical Practice, 31(3), 1-12. doi:https://doi.org/10.1111/jep.70046
  36. Zadow, A. J., Dollard, M. F., Dormann, C., & Landsbergis, P. (2021). Predicting new major depression symptoms from long working hours, psychosocial safety climate and work engagement: a population-based cohort study. BMJ open, 11(6), 1-14. doi:https://doi.org/10.1136/bmjopen-2020-044133
  37. Zarandona, J., Labaka, A., Unanue?Arza, S., & Lapkin, S. (2025). Nursing Students' Behavioral Intentions Toward Medication Safety: A Cross?Sectional Study Based on the Theory of Planned Behavior. Nursing & health sciences, 27(4), 1-12. doi:https://doi.org/10.1111/nhs.70258