The Impact of Leader-Member Relationships on Team Effectiveness Through Speaking Up and Silence: A Cross-Sectional Study in Rural Chinese Hospitals.

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 (β=0.61, p<0.01; β=0.17, p<0.01 respectively) and to silence (β=0.41, p<0.01; β=0.63, p<0.01 respectively). Speaking up is positively related to the perceived quality of care (β=0.24, p<0.01; β=0.46, p<0.01) and job satisfaction (β=0.30, p<0.01; β=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 (β=0.15, p<0.01; β=0.08, p<0.01 respectively) and job satisfaction (β=0.30, p<0.01; β=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.