Wang Hujie, Buljac-Samardzic Martina, van Wijngaarden Jeroen David Hendrikus, van de Klundert Joris
Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands.
School of Business, Universidad Adolfo Ibáñez, Santiago, Chile.
J Healthc Leadersh. 2024 Dec 12;16:543-555. doi: 10.2147/JHL.S460900. eCollection 2024.
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.
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.
Leader-member perceived similarity and power distance orientation are positively related to speaking up (=0.61, <0.01; =0.17, <0.01 respectively) and to silence (=0.41, <0.01; =0.63, <0.01 respectively). Speaking up is positively related to the perceived quality of care (=0.24, <0.01; =0.46, <0.01) and job satisfaction (=0.30, <0.01; =0.54, <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 (=0.15, <0.01; =0.08, <0.01 respectively) and job satisfaction (=0.30, <0.01; =0.54, <0.01 respectively).
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.
尽管团队合作中领导成员关系的重要性在文献中已得到认可，但对这种关系仍缺乏更深入的理解，尤其是在农村地区。在中国农村医院，领导成员关系对团队成果的影响尤为重要，因为改善团队合作是这些医院国家卫生改革的重点。本研究调查领导成员关系（即领导成员感知到的相似性和权力距离取向）如何通过表达意见和沉默来影响团队成果（即感知到的护理质量和工作满意度）。
2022年10月，中国四家农村医院的300个团队的1017名团队成员（即医生、护士和其他医疗专业人员）完成了一份在线问卷。该问卷测量了领导成员感知到的相似性、权力距离取向、表达意见、沉默、感知到的护理质量、工作满意度以及控制变量。进行了多层次中介分析以检验假设。
领导成员感知到的相似性和权力距离取向与表达意见呈正相关（分别为=0.61，<0.01；=0.17，<0.01），与沉默也呈正相关（分别为=0.41，<0.01；=0.63，<0.01）。表达意见与感知到的护理质量呈正相关（分别为=0.24，<0.01；=0.46，<0.01）和工作满意度呈正相关（分别为=0.30，<0.01；=0.54，<0.01），而沉默的影响不显著。最后，表达意见在领导成员感知到的相似性和权力距离取向与感知到的护理质量（分别为=0.15，<0.01；=0.08，<0.01）以及工作满意度（分别为=0.30，<0.01；=0.54，<0.01）之间起中介作用。
表达意见而非沉默，通过调节领导成员关系对团队成果的影响来促进团队运作。因此，医院管理层可能会通过关注领导成员关系来寻求激发表达意见：增加领导成员的相似性并促进成员的权力距离取向。然而，通过这些领导成员关系导致沉默增加的任何意外影响是未来研究的一个重要领域，该研究可以采用表达意见和沉默的多维模型。
