THE INFLUENCE OF LEADERSHIP ON IMPROVING SERVICE QUALITY IN PUSKESMAS: A CONCEPTUAL LITERATURE REVIEW (2021–2025)

Abstract

Leadership in primary health care facilities (Puskesmas) is a critical determinant of service quality and organizational performance. This conceptual literature review synthesizes empirical and theoretical studies published between 2021 and 2025 to explore how leadership affects service quality outcomes in Indonesia’s community health centers. Using an integrative conceptual approach, this paper analyzes leadership theories (transformational, clinical, servant, and participatory), mediating mechanisms (motivation, empowerment, communication, and continuous quality improvement), and contextual moderators (governance, financing, human resources, and health information systems). The review finds that transformational and clinical leadership consistently enhance staff satisfaction, engagement, and adherence to clinical standards, leading to better patient-centered care and accreditation readiness. However, leadership effectiveness is constrained by systemic barriers, including limited autonomy, workforce shortages, and fragmented health information systems. The paper concludes with recommendations for structured leadership development, integration of leadership indicators into performance systems, and simultaneous investments in enabling environments to sustain quality improvement in Puskesmas.