Organizational culture as a mediator of credible leadership influence on work engagement: empirical studies in private hospitals in East Java, Indonesia

Hospitals require engaged and productive health and non-health workers to deliver effective and high-quality services. Work engagement underpins organizational competitiveness and performance, but can decline during crises such as the COVID-19 pandemic, necessitating leadership-driven initiatives to sustain engagement. Leadership and organizational culture are central drivers of engagement: leaders act as sense-givers who set values and norms, and leadership practices (e.g., credible, ethical, transformational) have been linked to higher engagement, trust, and performance. Credible leadership—characterized by honesty, competence, inspiration, and forward-looking vision—builds trust and fosters an engaging climate. Organizational culture has also been identified as a key antecedent of engagement, with strong, supportive cultures empowering employees and enhancing involvement. In the context of two rapidly developing private hospitals in Madiun City, East Java, Indonesia (Siti Aisyah Islamic Hospital and St. Clara Hospital), this study investigates whether credible leadership influences organizational culture and work engagement, and whether organizational culture mediates the credible leadership–engagement link. Research questions: (1) Does credible leadership positively and significantly influence organizational culture? (2) Does organizational culture positively and significantly influence work engagement? (3) Does credible leadership significantly influence work engagement with organizational culture as a mediator?

Theoretical framework and hypotheses center on three constructs. Credible leadership refers to a leader’s trustworthiness and influence, encompassing demonstrated competence during turbulence, honorable intentions, commitment to learning, cultural agility, future orientation, and fostering creativity/innovation (Quist, 2009). Kouzes and Posner highlight honesty, inspiration, competence, and vision as core credibility attributes. Credible leaders create engaging cultures by building trust, communicating strategy, aligning HR practices, managing change, and developing leaders at all levels (Matthews, 2008). Organizational culture comprises shared values, norms, and behaviors shaping the social environment (Stone et al., 2007), with Denison and Mishra’s dimensions: involvement, consistency, adaptability, and mission. Indonesian cultural attributes include integrity, professionalism, praiseworthy conduct, and respect for human resources. Work engagement is a positive, work-related state characterized by vigor, dedication, and absorption (Schaufeli, 2013; UWES). Prior empirical evidence links leadership styles (transformational, transactional, ethical, authentic, charismatic) to organizational culture and engagement, and indicates culture can mediate leadership effects on outcomes. Hypotheses: H1: Credible leadership positively influences organizational culture. H2: Organizational culture positively influences work engagement. H3: Credible leadership influences work engagement through organizational culture (mediation). A research model (Fig. 1) specifies paths: CL→OC (a), OC→WE (b), CL→WE (c), and CL→WE controlling for OC (c′).

Design: Quantitative, causal study examining direct and indirect effects of credible leadership (CL) on work engagement (WE) with organizational culture (OC) as mediator. Setting and sample: Two private type C hospitals in Madiun City, East Java, Indonesia: Siti Aisyah Islamic Hospital and Santa Clara Hospital. Quota sampling of full-time, non-managerial medical and non-medical personnel, proportional to staff composition. Distributed questionnaires: 185 at Siti Aisyah (110 medical, 75 non-medical) and 100 at Santa Clara (75 medical, 25 non-medical). Usable responses: 255 (≈89.48%). Respondent characteristics: 75.29% female (n=192), 24.7% male (n=63); 63.14% medical (n=161), 36.86% non-medical (n=94). Measures: - Credible leadership: Four dimensions from Kouzes and Posner (honesty/integrity, authority/power, capability/managerial, visionary), 35 items, 5-point Likert (1=strongly disagree to 5=strongly agree). Respondents rated direct supervisors. - Organizational culture: Four dimensions reflecting Indonesian organizational attributes (integrity, professionalism, praiseworthy, recognition for human resources), 13 items, 5-point Likert. - Work engagement: UWES (Schaufeli & Bakker, 2000), 17 items across vigor, dedication, absorption; frequency scale (1=never to 5=always). Analysis: Structural equation modeling (SEM) using LISREL 8.70 for CFA and model fit; path analysis for direct effects; mediation tested via Sobel test (quantpsy.org). Validity and model fit: Convergent validity supported by factor loadings >0.50. Key loadings: CL—honesty/integrity 0.99, authority/power 0.55, capability 0.76, visionary 0.75; OC—integrity 0.53, professionalism 0.67, praiseworthy 0.73, recognition HR 0.87; WE—vigor 0.96, dedication 0.56, absorption 0.62. Model fit indices indicated acceptable fit: Chi-square=168.71 (p=0.00), RMSEA=0.000, RMR=0.026, ECVI=0.52 (near saturated 0.68), GFI=0.89, NNFI=0.87, NFI=0.87, AGFI=0.89, RFI=0.83, IFI=0.90, CFI=0.90, PGFI=0.55, PNFI=0.65. Descriptive statistics (means): CL=3.83 (high), OC=3.97 (high), WE=4.18 (very high).

• Descriptive outcomes: Mean CL 3.83 (high); OC 3.97 (high); WE 4.18 (very high). Sample: 255 usable responses (89.48%); 75.29% female; 63.14% medical personnel. - Measurement validity: All factor loadings ≥0.53 except some in mid-range; WE vigor loading 0.96; overall CFA supports convergent validity. - Model fit: Acceptable based on multiple indices (e.g., RMSEA=0.000; RMR=0.026; CFI=0.90). - Hypothesis testing (standardized coefficients, t-values, p-values): H1 (CL→OC, path a): β=0.389, t=5.671, p=0.000—significant positive effect. H2 (OC→WE, path b): β=0.173, t=2.642, p=0.009—significant positive effect. Direct effect CL→WE before mediator (path c): β=0.157, t=1.816, p=0.014—significant. Direct effect CL→WE controlling for OC (path c′): β=0.055, t=0.843, p=0.400—not significant. - Mediation: Sobel test for CL→OC→WE: test statistic=2.401, SE=0.033, p=0.016—significant indirect effect. Since c′ becomes non-significant when OC is included, OC acts as a perfect mediator between CL and WE. - Interpretation: Credible leadership significantly strengthens organizational culture, which in turn significantly enhances work engagement; the effect of credible leadership on engagement operates entirely through organizational culture in this context.

Findings confirm that credible leadership—embodying honesty, integrity, managerial capability, and vision—shapes a strong organizational culture characterized by integrity, professionalism, praiseworthy conduct, and recognition of human resources. This cultural environment fosters higher work engagement (vigor, dedication, absorption) among hospital staff. The mediation results indicate that credible leadership affects engagement indirectly via the internalization of cultural values and practices, aligning with prior literature that leadership influences culture and culture drives engagement. The high proportion of female and medical personnel may contextualize the strong culture–engagement link in hospitals, where supportive, just, and inclusive cultures and credible supervisory behavior can be especially salient for sustaining engagement under complex, high-demand conditions. Practically, hospital leaders should prioritize credibility-building behaviors and culture stewardship—transparent communication, alignment of HR practices with strategy, fair recognition, and development—to elevate engagement and, by extension, service quality and outcomes.

Credible leadership significantly improves organizational culture, and organizational culture significantly enhances work engagement among medical and non-medical hospital staff. Organizational culture perfectly mediates the relationship between credible leadership and work engagement, indicating that leadership’s impact on engagement operates through cultural mechanisms. Managerially, hospitals should develop and reinforce credible leadership behaviors at all levels and systematically internalize superior cultural values to strengthen engagement, particularly among frontline caregivers where engagement links to patient outcomes. Future research should extend to additional hospitals and sectors, examine alternative leadership styles (e.g., integrative leadership), incorporate additional antecedents of engagement (e.g., work–family enrichment), explore alternative culture typologies (clan, adhocracy, hierarchy, market), and assess downstream outcomes such as employee loyalty and retention.

• Self-report survey design may introduce common method bias and response biases. - Sampling limited to two type C private hospitals in Madiun City; three other type C hospitals in the area were not included, limiting generalizability. - Focused scope on credible leadership and organizational culture as predictors of engagement; other relevant antecedents (e.g., work–family enrichment) not modeled. - Organizational culture operationalized with specific dimensions; other culture typologies (clan, adhocracy, hierarchy, market) were not assessed.