Abstract: The contemporary healthcare sector necessitates a sophisticated understanding of the intricate relationships among leadership approaches, organizational culture, and employee engagement to optimize patient care and organizational performance. This systematic review synthesizes findings from 89 empirical studies published between 2020 and 2025, examining organizational culture as a critical mediating variable between diverse leadership styles and employee engagement outcomes in healthcare organizations. Employing a mixed-methods approach, the review integrates quantitative meta-analytical methods with qualitative thematic analysis to provide a comprehensive perspective on cultural mediation processes across healthcare settings.

The principal findings demonstrate that organizational culture serves as a complete mediator in the relationship between credible leadership and work engagement (β = 0.389, p < 0.001). Comparable mediating effects are observed for transformational leadership (β = 0.341, p < 0.001), authentic leadership (β = 0.327, p < 0.001), and servant leadership (β = 0.312, p < 0.001). Healthcare organizations characterized by strong cultures of integrity, professionalism, trust, and recognition of human resources report employee engagement scores 43% higher than those with less developed cultures. The review identifies four key cultural dimensions that consistently mediate the leadership-engagement relationship: involvement (β = 0.286, p < 0.001), consistency (β = 0.274, p < 0.001), adaptability (β = 0.267, p < 0.001), and mission clarity (β = 0.291, p < 0.001).

Gender dynamics significantly influence cultural mediation processes, with female healthcare workers exhibiting stronger responses to participatory and supportive cultural elements, as reported by 75% of respondents. In contrast, leadership credibility demonstrates effectiveness across all demographic groups. These findings contribute to healthcare management theory by underscoring organizational culture as a central mechanism for leadership effectiveness and provide actionable strategies for healthcare administrators seeking to enhance employee engagement through targeted cultural interventions.