Abstract

Introduction: Although the importance of leader-member relationships in teamwork is acknowledged in literature, a deeper understanding of this relationship is lacking, especially in rural areas. The impact of leader-member relationships on team outcomes is especially important in rural Chinese hospitals as improving teamwork forms a national health reform priority in these hospitals. This study investigates how leader-member relationships (ie leader-member perceived similarity and power distance orientation) influence team outcomes (ie perceived quality of care and job satisfaction) via speaking up and silence. Methods: An online questionnaire was completed by 1017 team members (ie doctors, nurses and other healthcare professionals) of 300 teams in four rural Chinese hospitals in October 2022. The questionnaire measured leader-member perceived similarity, power distance orientation, speaking up, silence, perceived quality of care, job satisfaction and control variables. Multilevel mediation analysis was conducted to test the hypotheses. Results: Leader-member perceived similarity and power distance orientation are positively related to speaking up (beta=0.61, p< 0.01; beta=0.17, p< 0.01 respectively) and to silence (beta=0.41, p< 0.01; beta=0.63, p< 0.01 respectively). Speaking up is positively related to the perceived quality of care (beta=0.24, p< 0.01; beta=0.46, p< 0.01) and job satisfaction (beta=0.30, p< 0.01; beta=0.54, p< 0.01), while the impact of silence is not significant. Finally, speaking up mediates the associations of both leader-member perceived similarity and power distance orientation with perceived quality of care (beta=0.15, p< 0.01; beta=0.08, p< 0.01 respectively) and job satisfaction (beta=0.30, p< 0.01; beta=0.54, p< 0.01 respectively). Conclusion: Speaking up, rather than silence, contributes to team functioning by mediating the impact of leader-member relationships to team outcomes. Hospital management may therefore seek to stimulate speaking up by focussing on leader-member relationships: increasing leader-member similarity and promoting members' power distance orientation. However, any unintended effect of increased silence through these leader-member relationships is an important area of future research, which can adopt multidimensional models of speaking up and silence.