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This study examines the effect of servant leadership and high performance work system (HPWS) on employee retention and employee performance with employee engagement as a mediating variable. The sample in this study were 138 employees of private hospitals in Medan City. Data collected through questionnaires were analyzed by data analysis methods using Structural Equation Modeling (SEM) which is operationalized with the Analysis of Moment Structure (AMOS) tool. The results showed that servant leadership and high performance work system have a significant effect on employee engagement, employee retention and employee performance. Employee engagement has a direct effect on employee retention and also on employee performance. then in testing the indirect effect of employee engagement was found to play a role as a partial mediating variable in the relationship between the influence of servant leadership and high performance work system (HPWS) on employee retention and employee performance. The results of this study are expected to be important information for private hospital leaders in making policies related to the development of employee retention and employee performance in private hospitals.

servant leadership, high performance work system, employee retention, employee engagement