The impact of leader member exchange quality and differentiation on counterproductive and citizenship behavior in health care teams.

Background: Organizational citizenship behavior (OCB) may increase service quality. In contrast, counterproductive work behavior (CWB) may undermine patient safety. Efforts to increase OCB and reduce CWB rely on a good understanding of their antecedents, yet there is a lack of research in health care to inform such endeavors.

Purpose: The aim of this study was to investigate the role of leadership, specifically leader-member exchange (LMX), in reducing CWB and increasing OCB in health care teams.

Methodology/approach: Team survey data were collected from 75 teams in U.S. health services organizations. Polynomial regression and response surface analysis was used to investigate our hypotheses.

Results: For OCB, the response surface along the line of incongruence (a3) was positive and significant, and for CWB, a3 was negative and significant.

Conclusion: The results of polynomial regression and response surface analysis indicate that OCB increases when LMX quality is high and that LMX differentiation is comparatively lower. In contrast, CWB increases when LMX differentiation is high, whereas LMX quality is lower.

Practice implications: These findings provide useful suggestions to promote valuable extra-role behaviors in health care teams. Health care team leaders should aim to develop strong exchange relationships with all members if they wish to increase citizenship behavior and decrease counterproductive behavior. Building positive exchange relationships with only a few team members is likely to undermine citizenship behavior and increase counterproductive behavior.