The Dynamics of Distributed Leadership and Organizational Citizenship Behavior in Healthcare: Moderated Mediation of Psychological Capital and Emotional Exhaustion

This study examines how distributed leadership (DL) influences organizational citizenship behavior (OCB) among healthcare professionals, focusing on the mediating and moderating mechanisms of psychological capital (PsyCap) and emotional exhaustion (EE), respectively. Drawing on social exchange theory, we develop and test a moderated mediation framework to explain the psychological and behavioral pathways that link DL with OCB. Data were collected from 503 healthcare professionals using validated, self-administered questionnaires and a multimodal sampling approach. Analyses were conducted with confirmatory factor analysis and Hayes' PROCESS macro. Results revealed that DL positively predicts PsyCap and OCB, with PsyCap partially mediating the relationship between DL and OCB. Importantly, EE moderates the indirect pathway between DL and OCB, suggesting that even under high EE, the DL - PsyCap - OCB pathway remains significant, highlighting DL's capacity to foster positive outcomes in stressful contexts. This study provides novel empirical evidence of PsyCap's mediating role and EE's moderating influence in the DL - OCB relationship, a dynamic previously overlooked in healthcare and addresses a significant gap in organizational research. Findings extend organizational psychology by establishing DL as an effective leadership approach that strengthens psychological resources, mitigates burnout, and promotes citizenship behaviors.