Transformational leadership and quality management in health reforms in Kosovo

Abstract

Healthcare reform in transitional systems requires effective leadership and robust quality-management frameworks to improve service quality and patient outcomes. Kosovo’s healthcare sector still faces organisational challenges requiring evidence-based strategies to strengthen institutional performance and patient-centred care. This study examines the influence of transformational leadership on quality management processes within the healthcare reforms in Kosovo. The research evaluates whether leadership behaviours facilitate improvements in patient satisfaction, service quality, and institutional efficiency through SERVQUAL and Six Sigma models/methods. A mixed-method research design was applied. Quantitative data were collected through structured SERVQUAL and Multifactor Leadership Questionnaire (MLQ) instruments from 300 healthcare professionals across 10 hospitals (6 public, 4 private). Qualitative insights were gathered through semi-structured interviews with senior managers. Statistical analysis included descriptive indicators, correlation analysis, and multiple regression using SPSS. Qualitative data were subjected to thematic analysis. Based on national law the Ethical approval was not needed as the study did not include biochemical analyses, whereas all participants gave informed consent. Transformational leadership significantly predicted improved service quality (R² = 0.64, p < 0.001). Inspirational motivation ( = 0.34), idealised influence ( = 0.28) and intellectual stimulation ( = 0.21) were the strongest predictors of perceived service quality. SERVQUAL analysis revealed the largest gaps in responsiveness (–0.6) and empathy (–0.6). Implementation of Six Sigma DMAIC in one pilot hospital reduced waiting times by 23% and increased patient satisfaction scores by 17%. Transformational leadership fosters a culture of excellence and accountability, enabling effective implementation of quality management tools. Integrated leadership and Six Sigma/SERVQUAL frameworks are essential for advancing health reforms in Kosovo and aligning them with European quality standards.