Exploring the nexus of high-performance work systems and ethical leadership on employee attitudes and behaviours: case study evidence from healthcare

Purpose This study explores the role of high-performance work systems (HPWS) and ethical leadership in influencing employee affective commitment (AC) and organisational citizenship behaviours (OCB) in two large tertiary public hospitals in Pakistan. Design/methodology/approach Employing a case study approach, survey data were gathered from 814 front-line doctors and nurses. SPSS and AMOS were used for data cleaning and analysis, and structural equation modelling was deployed for hypothesis testing. Findings Our findings suggest that in both hospitals, affective commitment significantly and positively mediated the relationship between (1) HPWS and OCB and (2) ethical leadership and OCB. However, the role of ethical leadership as a boundary variable was significant in one hospital but insignificant in the other hospital. Research limitations/implications The research was cross-sectional, and data were collected from a convenient sample from two public hospitals in Pakistan, which affects our ability to generalise the findings to different contexts too broadly. Originality/value This study presents a unique and important contribution by highlighting a probable psychological mechanism through which ethical leaders implementing HPWS influence employee attitudes and behaviours (AC and OCB) within the Pakistani public health sector. By examining the leadership-HPWS relationship in this sector, our study tests the applicability of Western concepts (HPWS) in a developing country and the public health sector context, with some of the findings being inconsistent with extant evidence as it pertains to the outcomes of the leadership-HPWS relationship. Further, our study demonstrates the value of case study research in examining complex phenomena.