Background: Leadership support is vital for developing a patient safety culture, particularly in complex hierarchical healthcare settings like Saudi Arabia. Although the importance of leadership in supporting a positive safety culture has been well established, there has been controversy over the best leadership mechanisms. 
Aim: The study aims to investigate the relationship between leadership support and patient safety culture in Saudi healthcare facilities, and the role of adaptive leadership in eliminating cultural and organisational barriers to safety. 
Method: The synthesis of the existing literature on leadership and patient safety culture was conducted using a narrative review approach. The relevant publications were located in databases such as PubMed, Scopus, Web of Science, and Google Scholar using keywords related to leadership, patient safety culture, and Path-Goal Leadership Theory. The selected articles were analysed using thematic analysis to identify the significant findings and concepts. 
Results: The review identified that patient safety culture is positively affected by supportive leadership, characterized by psychological safety, open communication, and collaboration with the team. The Path-Goal Leadership Theory has become one of the most effective approaches to changing leadership styles based on the needs of a team and the situation, especially in multicultural settings such as Saudi Arabia. 
Conclusion: Adaptive leadership, guided by the Path-Goal Theory, is necessary to improve patient safety culture in Saudi healthcare environments. By adapting their leadership style to team needs and cultural backgrounds, leaders can create safer, more effective care environments.