Background: Hospital laboratories are central to clinical decision-making, yet performance improvement initiatives have predominantly focused on technical accuracy and accreditation compliance. Limited attention has been given to the institutional and professional dynamics that shape laboratory quality outcomes.

Objective: This systematic review aimed to synthesize empirical evidence examining the relationships among institutional culture, governance mechanisms, professional identity, and clinical performance in hospital laboratory settings.

Methods: The review was conducted and reported in accordance with PRISMA 2020 guidelines. A structured search was performed across Scopus, Web of Science, PubMed, and Google Scholar for studies published between 2005 and 2025. Eligible studies were empirical investigations conducted in hospital laboratories that examined at least one of the following constructs: organizational or institutional culture, governance/accreditation systems, or professional identity, alongside measurable performance outcomes. Twenty-six studies met the inclusion criteria and were included in the qualitative synthesis. Methodological quality was assessed using JBI and CASP appraisal tools.

Results: Governance mechanisms such as accreditation and structured quality management systems were associated with improved procedural standardization and accountability. However, performance gains varied across institutional contexts. Positive organizational and safety cultures were consistently linked to enhanced reporting behavior and engagement with quality initiatives. Evidence regarding laboratory-specific professional identity was limited but suggests that alignment between professional values and governance structures strengthens compliance and quality engagement. Performance improvements were most pronounced when governance mechanisms operated within supportive cultural environments.

Conclusion: Laboratory clinical performance reflects a layered interaction among regulatory accountability, organizational culture, and professional identity. Sustainable quality improvement requires alignment across these domains rather than reliance on procedural compliance alone.