Why employees withhold knowledge: the role of job demands, unfairness perceptions and knowledge power threat in a healthcare setting

PURPOSE: While job demands are commonly linked to burnout and disengagement, their influence on knowledge withholding remains underexplored, particularly in high-stakes healthcare settings where knowledge sharing is critical. Specifically, existing frameworks explain general stress responses but do not account for knowledge-specific and strategic decisions, nor the cognitive mechanisms underlying such behaviour. This study investigates the psychological mechanisms and boundary conditions through which job demands lead to knowledge withholding. DESIGN/METHODOLOGY/APPROACH: Drawing on conservation of resources (COR) theory, this study examines the mediating role of perceived reward-effort unfairness and the moderating role of knowledge power threat (KPT). Data were collected using a time-lagged design from 316 healthcare professionals across multiple organisations in the UAE. Structural equation modelling (SEM) was used to test the hypothesised relationships. FINDINGS: The results indicate that job demands positively influence knowledge withholding through perceived unfairness in reward-effort balance. This suggests that employees cognitively interpret resource imbalances as unfair, which in turn shapes knowledge-related decisions. Moreover, the relationship is intensified by KPT, reflecting employees' anticipatory concerns about losing knowledge-based influence and professional value, leading to stronger knowledge withholding behaviour. PRACTICAL IMPLICATIONS: The findings highlight the importance of managing workload, ensuring fair reward systems and fostering trust-based leadership to reduce knowledge withholding and promote knowledge-sharing behaviours in healthcare organisations. ORIGINALITY/VALUE: This study provides a more precise explanation of knowledge withholding by integrating resource-based, cognitive and power-related perspectives, with KPT introduced as a novel boundary condition.