This research aimed to study the effect of leadership (transformational and transactional) on turnover intentions and whether this relationship is mediated by organisational commitment and moderated by the department of activity. To this end, it was hypothesized that: (1) leadership has a negative and significant association with turnover intentions; (2) leadership has a positive and significant association with affective organisational commitment; (3) organisational commitment has a negative and significant association with turnover intentions; (4) organisational commitment has a mediating effect on the relationship between leadership and turnover intentions; (5) the department to which the employee belongs has a moderating effect on the relationship between leadership and organisational turnover intentions. The sample consists of 477 participants working at the Hospital Professor Doutor Fernando Fonseca (HFF) in Portugal, performing their functions in several departments. This is a quantitative, correlational, and cross-sectional study. The results indicate that transformational leadership has a negative and significant effect on turnover intentions and a positive and significant effect on affective and normative commitment. Transactional leadership negatively and significantly affects all three components of organisational commitment. Affective and normative commitment has a negative and significant effect on turnover intentions. Calculative commitment has a positive and significant effect on turnover intentions. Affective commitment and calculative commitment have a partial mediating effect on the relationship between transformational leadership and organisational turnover intentions. The department to which the employee belongs does not have a moderating effect on the relationship between leadership and turnover intentions. It has been proven that leadership plays an extremely important role in the smooth running of this hospital unit.

Background: Public healthcare systems face persistent workforce retention challenges that undermine service continuity, organizational resilience, and public value creation. Although leadership is frequently identified as a relevant lever, the literature remains theoretically fragmented and often treats leadership effects as direct and context-free. Methods: This review adopts a PRISMA-guided systematic literature review as a theory-building strategy. Searches were conducted in Web of Science, Scopus, and PubMed using combinations of terms related to leadership, organizational commitment, job satisfaction, turnover intention, and retention in healthcare settings. The review identified 640 records, removed 372 duplicates, screened 268 titles and abstracts, assessed 90 full-text records for eligibility, and retained 30 peer-reviewed studies for configurative synthesis. The analysis combined thematic synthesis with configurative mapping to identify mechanisms, recurring patterns, and contextual contingencies. Results: The review shows three consistent patterns. First, leadership is linked to retention predominantly through organizational commitment, especially affective and normative commitment, rather than through direct effects. Second, institutional and organizational conditions—particularly red tape and working conditions—shape the strength of leadership–commitment relationships. Third, workforce heterogeneity, including generational differences, affects how leadership practices and organizational environments are interpreted, although these dynamics are rarely theorized explicitly in the literature. Conclusions: The article develops a governance-sensitive integrative framework in which people-centered leadership influences turnover intentions indirectly through organizational commitment, while red tape and working conditions operate as contextual moderators. By embedding leadership within Public Administration and governance theory, the review clarifies the literature’s main explanatory gap and provides a foundation for comparative empirical testing and for more sustainable workforce strategies in public healthcare systems.

Public sector organizations face persistent challenges in workforce retention, particularly in institutionally complex and resource-constrained environments. Although leadership is widely recognized as a key factor, research remains fragmented across the public administration and human resource management literature. This article develops a governance-sensitive framework to explain how leadership influences workforce retention in public service organizations. Drawing on a PRISMA 2020-guided systematic review of 30 studies, it integrates insights to examine the relationships between people-centered leadership, organizational commitment, and turnover intentions. The synthesis suggests that leadership effects are primarily indirect, operating through affective organizational commitment. Administrative burden (red tape) and working conditions emerge as key contextual factors shaping these relationships. The study contributes by offering an integrated framework and identifying implications for managing workforce retention in public healthcare organizations and comparable institutionally dense public service settings. The article proposes an integrated conceptual framework for future empirical research.