The silent struggle of employees under toxic leadership in the healthcare sector

Purpose Employee silence is a significant organisational issue that can adversely affect effective communication, organisational learning and patient safety in healthcare organisations. Although existing research has revealed significant associations between toxic leadership and employee silence, it has not yet been sufficiently clarified under which conditions this relationship is strengthened, particularly in the context of healthcare services. This study aims to examine the relationship between toxic leadership and employee silence in the Turkish healthcare sector and to assess the moderating role of work-related stress in this relationship. Design/methodology/approach A sequential mixed-methods design was employed. Quantitative data were collected through a questionnaire completed by 161 healthcare workers, whilst qualitative data were obtained through semi-structured interviews with 14 doctors. Findings The quantitative findings indicate that toxic leadership has a positive effect on employee silence and that different dimensions of work-related stress reinforce this relationship. The qualitative findings reveal that organisational hierarchies, communication barriers and organisational culture further reinforce employee silence in a toxic leadership environment. Originality/value By highlighting the moderating role of work-related stress in the healthcare context, this study provides a more comprehensive explanation of the conditions under which the relationship between toxic leadership and employee silence is strengthened. The findings also contribute to managerial practices aimed at promoting employee voice in healthcare organisations.