Toxic Leadership and Employees' Silence in the Public Sector: The Mediating Role of Emotional Exhaustion and the Moderating Effect of Cultural Values

This study examines the impact of toxic leadership on employee silence in public healthcare institutions within Sukkur Division, Sindh, Pakistan. Although prior studies have mostly focused on corporate settings, little is known about how toxic leadership shapes employee silence in public healthcare systems of developing countries. This study proposes emotional exhaustion as the mediating variable and cultural value as a moderating variable for the indirect effect. The study employed a cross-sectional and quantitative design, collecting data from 255 employees working in District Health Offices, Basic Health Units, and public hospitals. Validated measurement scales were applied, and data were analyzed using SmartPLS 4.0 to examine direct, mediated, and moderated relationships. The results showed that toxic leadership has a significant impact on employee silence, with emotional exhaustion serving as a mediator. Additionally, cultural values such as collectivism and power distance moderated the indirect effect, with employees in high power-distance and collectivist environments being more likely to remain silent when emotionally exhausted. The study advances the literature by examining toxic leadership within Pakistan's public healthcare sector, an area that has received negligible attention in prior research. The findings suggest that healthcare organizations should focus on reducing toxic leadership and promoting open communication channels, as well as providing culturally sensitive leadership development and emotional support systems to improve employee engagement and reduce silence.