Leading with care: the multidimensional role of LMX in connecting servant leadership and women's engagement in healthcare

Purpose This study examines the role of servant leadership (SL) in women employees' engagement (EE) in the healthcare sector, incorporating leader–member exchange (LMX) as a multidimensional intervening mechanism. Drawing upon the theory of cooperation and competition, the study suggests that SL enhances women's engagement at work and that distinct LMX dimensions exert varied conceptual and practical influences on EE. Design/methodology/approach Using a time-lagged survey design, data were gathered from 499 female nurses and doctors in two phases. Structural equation modelling (SEM) using SMART-PLS 3 was employed to analyse the proposed hypotheses. Findings Results revealed a positive effect of SL on women's EE. Mediation analysis showed that LMX-Affect and LMX-Contribution significantly mediated the relationship, while LMX-Loyalty and LMX-Professional Respect did not exhibit significant indirect effects. The findings underscore the importance of SL and LMX dimensions in promoting engagement among women healthcare workers and offer valuable theoretical insights and practical recommendations for EE strategies. Originality/value This study provides distinctive insights into SL, LMX and their influence on EE among female healthcare professionals. It showed that all relational exchanges do not contribute equally to women's engagement. The results highlighted that the general expectation of reciprocity can mislead the SL because each individual has their own expectation and the mutual interpersonal liking and attraction between a SL and a women employee may reduce engagement. Furthermore, the adoption of a time-lagged research design enhances methodological rigour by establishing temporal separation between the study variables.