Analysis of the Role of Transformational Leadership in Improving Employee Work Motivation and Performance and its Impact on Hospital Business Sustainability
JEL Classification: M12, M54, I11, I18, L25
Abstract
This study aims to analyze the influence of transformational leadership on work motivation, employee performance, and business sustainability at Pala Raya Hospital (RSIA Pala Raya) in Tegal Regency, and to examine the mediating role of work motivation and employee performance in this relationship. The background of this study is based on the decline in patient visits and hospital revenue, which raises the need for a sustainability strategy based on internal organizational strengthening. The research method used is a quantitative explanatory approach with a total sampling technique of 200 employee respondents, and data analysis was conducted using SEM-PLS through SmartPLS 4.0. The results show that transformational leadership has a significant and positive effect on work motivation and employee performance, and has an impact on the sustainability of the hospital's business. Work motivation has a stronger influence than performance on sustainability. The mediation test shows that work motivation is a significant mediator in the relationship between transformational leadership and business sustainability, while employee performance is not. The study also identified various obstacles in the implementation of transformational leadership, such as lack of training, bureaucratic culture, and a reward system that does not support innovation. These findings emphasize the importance of the role of inspirational and participatory leadership in building motivation and supporting hospital sustainability.
References
Alshammari, F., Alenezi, A., & Alotaibi, M. (2025). Transformational leadership, work–life balance, and nurse retention in hospital settings. BMC Nursing, 24(37), 1–12. https://doi.org/10.1186/s12912-025-02762-1
Ariyanti, N., & Sawitri, HSR (2024). The Effect of Transformational Leadership on Employee Performance Through Job Satisfaction, Organizational Commitment and the Use of Social Media in Public Organizations (Case Study of Financial Services Authority Employees). IJSSRR: International Journal of Social Science Research and Reviews , 7 (1), 240–254. https://doi.org/10.47814/ijssrr.v7i1.1859
Babu, D. M., & Kushwaha, B. P. (2024). Does Transformational Leadership Influence Employees' Innovativeness and Mediate the Role of Organizational Culture? Empirical Evidence. International Research Journal of Multidisciplinary Scope , 05 (01), 428–440. https://doi.org/10.47857/irjms.2024.v05i01.0244
Bachtiar, D. (2012). Bachtiar, D., Manajemen, J., & Ekonomi, F. (2012). Management Analysis Journal Pengaruh Motivasi Dan Lingkungan Kerja Terhadap Kinerja Karyawan. Management Analysis Journal, 1(1).
Bass, B. M., & Avolio, B. J. (1994). Improving Organizational Effectiveness through Transformational Leadership. Sage Publications, Inc.
Böttcher, T. P., Empelmann, S., Weking, J., Hein, A., & Krcmar, H. (2024). Digital Sustainable Business Models: Using Digital Technology to Integrate Ecological Sustainability into the Core of Business Models. Information Systems Journal, 34(3), 736–761. https://doi.org/10.1111/isj.12436
Chen, X., Li, Y., & Zhou, Q. (2025). The chain mediation of psychological empowerment and work engagement in the relationship between transformational leadership and ICU nurses’ performance. BMC Nursing, 24(57), 1–14. https://doi.org/10.1186/s12912-025-03057-1
Creswell, J. W. (2019). Research design pendekatan kualitatif, kuantitatif, dan mixed (A. Fawaid & S. Z. Qudsy, Eds.; 5th ed., Vol. 3). Yayasan Mitra Netra.
Darmawan, R. A., & Muttaqin, R. (2023). Pengaruh Gaya Kepemimpinan dan Motivasi terhadap Kinerja Karyawan dengan Kepuasan Kerja Sebagai Variabel Intervening (Survei Pada Divisi Pemasaran PT Fastrata Buana Cabang Cianjur). JEMSI: Jurnal Ekonomi, Manajemen, Dan Akuntansi, 9(6), 2795–2805. https://doi.org/10.35870/jemsi.v9i6.1733
El-Garaihy, W.H., Farag, T., Al Shehri, K., Centobelli, P., & Cerchione, R. (2024). Driving Sustainability in Supply Chain Management for a More Inclusive and Responsible Future. International Journal of Productivity and Performance Management, 73 (1), 43–84. https://doi.org/10.1108/IJPPM-01-2022-0028
Fujimoto, Y., Azmat, F., & Uddin, J. (2024). Inclusive leadership toward reshaping corporate purpose for sustainable development. Leadership, 20(5), 289-313. https://doi.org/10.1177/17427150241258878
Garad, A., Haryono, S., Yaya, R., Pratolo, S., & Rahmawati, A. (2022). The Relationship Between Transformational Leadership, Improving Employee’s Performance and the Raising Efficiency of Organizations. Management and Production Engineering Review, 15–30. https://doi.org/10.24425/mper.2022.142052
Gebreheat, G., Assefa, Y., & Mengistu, B. (2023). The influence of transformational leadership on nurses’ job satisfaction: A systematic review. Journal of Nursing Management, 31(2), 211–223. https://doi.org/10.1111/jonm.13700
Guan, X., Frenkel, S. J., & Yu, H. (2025). How supervisor thriving at work affect subordinates’ well-being and behavior: integrating job demands-resources and crossover theory. Leadership & Organization Development Journal, 46(2), 238-253. https://doi.org/10.1108/LODJ-03-2024-0157
Hajiali, I., Kessi, A. M. F., Budiandriani, B., Prihatin, E., & Sufri, M. M. (2022). Determination of work motivation, leadership style, employee competence on job satisfaction and employee performance. Golden Ratio of Human Resource Management, 2(1), 57-69.
Havig, A. K., Skogstad, A., Kjekshus, L. E., & Romøren, T. I. (2020). Leadership, staffing, and quality of care in nursing homes. BMC Health Services Research, 20(1), 949. https://doi.org/10.1186/s12913-020-05671-y
Iis, E. Y., Abubakar, R., & Maimunah, S. (2023). The effect of information technology utilization and employee competence on employee performance with job satisfaction as the intervening variable in the Aceh Irrigation Service. International Journal of Professional Business Review: Int. J. Prof. Bus. Rev., 8(7), 63. https://doi.org/10.26668/businessreview/2023.v8i7.2564
Imhanzenobe, J. (2021). Achieving competitive advantage and financial sustainability through acquisition and restructuring strategies. Journal of Accounting and Taxation, 13(3), 217-225. http://dx.doi.org/10.5897/JAT2021.0486
Jena, L. K., Pradhan, S., & Panigrahy, N. P. (2018). Pursuit of Organisational Trust: Role of Employee Engagement, Psychological Well-Being and Transformational Leadership. Asia Pacific Management Review, 23(3), 227–234. https://doi.org/10.1016/j.apmrv.2017.11.001
Khan, N. R., Malik, F., Khan, M. R., Khan, I., & Ghouri, A. M. (2025). Organizational Sustainability: The Role of Environmentally Focused Practices in Enhancing Environmental Performance—an Emerging Market Perspective. Discover Sustainability, 6(1), 73. https://doi.org/10.1007/s43621-025-00826-5
Kim, S. Y., Park, Y., & Lee, J. (2022). The effects of transformational leadership on burnout and work engagement among nurses. International Journal of Environmental Research and Public Health, 19(17), 10941. https://doi.org/10.3390/ijerph191710941
Liu, Y., Liu, Z., Chang, D., & Zhang, C. (2025). Unraveling the Effects of Leader Perfectionism on Team Dynamics: an Emotion-Motivation Perspective. Humanities and Social Sciences Communications, 12(1), 570. https://doi.org/10.1057/s41599-025-04565-w
Lopes, C. M., Scavarda, A. J., Vaccaro, G. L. R., Pohlmann, C. R., & Korzenowski, A. L. (2018). Perspective of Business Models and Innovation for Sustainability Transition in Hospitals. Sustainability, 11(1), 5. https://doi.org/10.3390/su11010005
Lukito, D., Susanti, M., Susanto, Y., Judijanto, L., Ali, M., Hartono, & Mahardhani, A. J. (2025). Determinants of Sustainable Employee Performance: A Study of Family Businesses in Indonesia. Asia Pacific Management Review, 30(2), 100340. https://doi.org/10.1016/j.apmrv.2024.12.004
Luo, J., Zaman, S. I., Jamil, S., & Khan, S. A. (2025). The future of healthcare: green transformational leadership and GHRM’s role in sustainable performance. Benchmarking: An International Journal, 32(3), 805-837. https://doi.org/10.1108/BIJ-08-2023-0523
Memon, A. H., Khahro, S. H., Memon, N. A., Memon, Z. A., & Mustafa, A. (2023). Relationship between job satisfaction and employee performance in the construction industry of Pakistan. Sustainability, 15(11), 8699. https://doi.org/10.3390/su15118699
Murtiningsih. (2015). Pengaruh Gaya Kepemimpinan Transformasional Pada Kinerja Perawat Rumah Sakit Islam Siti Aisyah Madiun. DAYA SAING: Jurnal Ekonomi Manajemen Sumber Daya, 17(2), 54–66.
Naamati-Schneider, L., & Zaks, O. (2021). Public hospitals in crisis: Managerial and strategic adaptation. Business Under Crisis, Volume II: Organisational Adaptations, 43-64. http://dx.doi.org/10.1007/978-3-030-76575-0_3
Novitasari, P., & Satriyo, B. (2016). Pengaruh Gaya Kepemimpinan Transformasional Dan Motivasi Kerja Terhadap Kinerja Karyawan. Jurnal Ilmu Dan Riset Manajemen, 5(9), 1–20.
Nurdiansyah, R., Mariam, S., Ameido, MA, & Ramli, AH (2020). Work Motivation, Job Satisfaction and Employee Performance. Business and Entrepreneurial Review , 20 (2), 153–162. https://doi.org/10.25105/ber.v20i2.8006
Peethambaran, M., & Naim, M. F. (2025). Unlocking employee flourishing in the hospitality industry: role of high-performance work systems, psychological capital and work passion. Journal of Hospitality and Tourism Insights, 8(1), 80-101. https://doi.org/10.1108/JHTI-12-2023-0906
Rahman, A., Kamaruzzaman, W., & Yusof, Z. (2021). The role of empowerment in the relationship between transformational leadership and job satisfaction among nurses in Malaysian hospitals. Human Resources for Health, 19(12), 1–9. https://doi.org/10.1186/s12960-016-0171-2
Riana, IG, Supartha, WG, & Tucunan, RJA (2014). The Influence of Transformational Leadership on Employee Motivation and Performance (Case Study at PT Pandawa). E-Journal of Economics and Business, Udayana University , 3 .
Roopa, M., Lakshminarayanan, S., Rodrigues, P. P., & Prabhu, N. (2025). Positive Influence of Organizational Politics on Job Performance in Indian Higher Education Context: A Qualitative Inquiry. South Asian Journal of Human Resources Management , 12 (1), 99–128. https://doi.org/10.1177/23220937231175601
Setiawan, E. Y. (2015). Pengaruh Gaya Kepemimpinan Transformasional dan Transaksional Terhadap Kinerja Karyawan PT ISS Indonesia di Rumah Sakit National Surabaya. MAGISTRA: E-Jurnal Ilmu Manajemen, 1(1).
Setiawan, Y., Qomariah, N., & Jember, U. M. (2022). The Role of Competence, Leadership, Work Environment and Motivation in Improving Employee Performance. International Journal of Humanities and Social Science Invention (IJHSSI), 11(2), 47-58.
Shafi, M., Zoya, Lei, Z., Song, X., & Sarker, MNI (2020). The Effects of Transformational Leadership on Employee creativity: Moderating Role of Intrinsic Motivation. Asia Pacific Management Review, 25 (3), 166–176. https://doi.org/10.1016/j.apmrv.2019.12.002
Stevens, J. (2025, February 10). Wellness at work and sustainable leadership practices. Investor’s Business Daily. https://www.investors.com/news/management/leaders-and-success/wellness-at-work-unleashes-healthier-long-term-success
Stevens, R. (2025). In sickness and in wealth: American hospitals in the twentieth century. Plunkett Lake Press.
Sugiyono. (2021). Metode Penelitian Kuantitatif, Kualitatif, dan R&D. Alfabeta.
Susanto, Najib, M., & Ekananta, A. (2021). Perencanaan Strategik Berorientasi Keberlanjutan Bisnis Menggunakan Triple Layer Business Model Canvas Studi Kasus: Ghi Training. JABM: Jurnal Aplikasi Bisnis Dan Manajemen, 7(2), 428. https://doi.org/10.17358/jabm.7.2.428
Susanto. (2021). Pengaruh Kepemimpinan Transformasional Dan Motivasi Kerja Terhadap Kinerja Karyawan. Jurnal Ekonomi Efektif, 3(2). https://doi.org/10.32493/JEE.v3i2.8733
Thu, SHT (2020). The Impacts of Transformational Leadership on Motivation of Employees: The Case of Employees at Vietnamese Small and Medium Enterprises. WSEAS Transactions on Business and Economics, 17, 21–32. https://doi.org/10.37394/23207.2020.17.4
Widaryanto, A. P., & Sari, M. N. (2024, December). Hospital Human Resource Management (HRM) Strategies in Facing Healthcare Workforce Crisis: Approaches for Efficiency and Sustainability. In Proceeding of International Conference on Economic Issues (Vol. 1, No. 1, pp. 664-682).
Yani, M., Saleh, A. R., Yuniarsih, N., Sunandar, D., Rohmalia, Y., Hubeis, M., & Ramly, A. T. (2021). Pengaruh Kepemimpinan Transformasional Terhadap Kinerja dan Motivasi Karyawan. Diversity: Jurnal Ilmiah Pascasarjana, 1(2). https://doi.org/10.32832/djip-uika.v1i2.4945
Zhao, L., Wang, J., & Hu, Y. (2025). Green transformational leadership and sustainable behavior among nurses. BMC Nursing, 24(64), 1–15. https://doi.org/10.1186/s12912-025-03331-2
Copyright (c) 2025 Journal La Bisecoman
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
