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Impact of toxic leadership on the Impact of toxic

leadership
intention to leave: a research
on permanent and contracted
hospital employees
Metin Reyhanoglu and Ozden Akin Received 20 May 2020
Revised 25 September 2020
Business Administration, Hatay Mustafa Kemal University, Antakya, Turkey Accepted 6 December 2020

Abstract
Purpose – This study aims to investigate the impact of toxic leadership, organizational justice and
organizational silence on hospital employees’ intention to leave their jobs.
Design/methodology/approach – A questionnaire survey was conducted with permanent and contractual
employees of a university teaching hospital, including nurses, medical assistants, health technicians and
clerical staff. Structural equation modeling was used to develop and test the model.
Findings – The findings reveal that toxic leadership is directly and negatively related to organizational
justice, while all dimensions of organizational silence and the intention to leave are positively related. In this
model, the coefficients of the relationships are found to be higher, almost doubling in permanent employees
than in contracted employees, except for the relationship between toxic leadership and silence to protect the
organization. This exception lies in the fact that permanent workers with long-term employment have been
dealing with the managers for many years.
Research limitations/implications – The model can be extended with counterproductive behavior, work
performance and satisfaction measures and work stress and compared with different sectors using higher
sample volumes.
Originality/value – In the human-centered health-care industry, it is essential to know the way leadership
behaviors guide health-care professionals. The negative leadership behaviors can negatively affect both
employees’ self-esteem and their attitudes toward patients and their relatives. The results of the present study
are expected to contribute to the development of more effective manager selection and promotion policies by
policy-makers as well as the determination of short- and long-term employment policies.
Keywords Toxic leadership, Organizational justice, Organizational silence, Intention to leave,
Health management
Paper type Research paper

1. Introduction
An efficient health-care system requires the involvement of outstanding and exhilarating
leadership to satisfy the employees and consumers (Labrague et al., 2020). Meanwhile, the
health systems also demand a highly qualified and supportive health-care team to meet the
needs of a society successfully (Chegini et al., 2019). Today, the increase in the elderly
population, society’s expectations for health services and health-care workers’ inabilities to
keep up with community services (Perreira et al., 2018), for example during the Covid-19
pandemic, causes health institutions to face serious difficulties. The high turnover rate of
health-care workers due to lousy leadership increases the workloads, subsides the job
performance and creates significant reductions in the quality and safety of patient care
(Perreira et al., 2016; Perreira et al., 2018, p. 1452).
As nurses are in continuous communication with patients and their relatives, they face the
risk of making more medical errors than other occupational groups (Tang et al., 2007, p. 449). In
this case, persistent exposure to a toxic managing authority makes the situation even worse in
terms of performance, work engagement and motivation of the health workers. Unlike other Journal of Economic and
Administrative Sciences
organizations, the occurrence of organizational silence (Yalçın and Baykal, 2012, p. 43) and © Emerald Publishing Limited
1026-4116
negative justice perceptions of health-care workers resulting from bad management in health DOI 10.1108/JEAS-05-2020-0076
JEAS institutions can cause irreversible consequences, leading to significant moral and conscientious
obligations (Morris, 2019; Bakkal et al., 2019). However, good managers of the organizations
can increase the service quality of health-care workers by creating a fair environment for their
employees and implicating the process of social synergy to guide, motivate and inspire other
individuals, teams or whole organizations. In this context, the leader or manager of an
organization must behave and direct his/her employees positively (Dasborough and
Ashkanasy, 2002) to create a distinguished social environment (Fahie, 2019). Influential
managers treat their employees fairly, increase organizational commitment, adopt the goals of
the organization, listen and empathize with their employees. The conducive leadership also
allows the employees to express themselves and thus increases their job satisfaction and keep
them in the organization (Smith and Fredricks-Lowman, 2019; Yaghi, 2019).
Ashforth (1994) stated that “bad managers” of the organizations affect the work
performance of employees. However, many managers of organizations often become
narcissistic and egomaniac in their attitude toward the employees, prioritizing their interests
over others and ignoring the work environment (Bhandarker and Rai, 2019). In other words,
toxic managers are considered responsible for poisoning the work potential of any
organization. It is essential to know that how bad managers or “toxic leaders” affect the
perception of justice in employees and raise their voices against adverse practices of an
organization, which is very crucial for the success and organizational performance of
employees (Laguda, 2020). The toxic managing practices may cause the employee to overlook
work assignments and even leave the organization, and thus, the organization may lose the
trained employee. Therefore, it is crucial to evaluate the effects of toxic leadership on
organizational justice for cost-efficient performance as the cost of recruitment is higher than
the cost of retention of an employee. Moreover, it is also necessary to find how the toxic
leadership directs employees to express themselves and leave their jobs.
Although the research on toxic leadership has focused on the military, political and business
fields (Smith and Fredricks-Lowman, 2019) previously, recent studies have started to pay much
scholarly attention regarding health institutions (Ozer€ et al., 2017). For instance, Kusy and
Holloway (2009, p. 5) stated that survey-based studies on health-care workers show growing
tendency of health employees working with a manager with toxic characteristics. Ample
literature is present studies on the relationship between toxic leadership (or similar concepts) and
organizational justice, organizational silence and intention to leave the job (Tepper, 2000;
Xu et al., 2015; Colquitt et al., 2001; Huang and Huang, 2016; Caylak and Altuntas, 2017).
However, none of the previous studies has discussed these concepts together in a statistical
model. Hence, this study aims to test a proposed structural equation model to determine the
effects of toxic leadership on organizational silence, organizational justice and intention to leave.
The research population includes health staff in public hospitals of Turkey employed with
permanent and contractual employment status. The employees with permanent positions have a
job guarantee, while those with a contract status need to renew their contract every year.
This paper is organized in four sections. The first section provides a comprehensive
literature review about theoretical and conceptual frameworks of toxic leadership,
organizational justice and organizational silence. Following is the development hypotheses
to test theoretical validity. In the next section, the data for authentication are analyzed, and
the result are interpreted accordingly. The final section includes a discussion and conclusion
of the research with some recommendations.

2. Literature review
2.1 Toxic leadership
Many studies on organizational leadership have tried to determine the attributes (Oreg and
Berson, 2011; Dasborough and Ashkanasy, 2002) and behaviors (Podsakoff et al., 1990)
associated with an effective leadership. On the other hand, some studies have also focused on Impact of toxic
the leader’s “bad” behaviors, in other words, showing the dark side of leadership (Ashforth, leadership
1994; Tepper, 2000; Hogan and Kaiser, 2005; Schmidt, 2008; Itzkovich et al., 2020; Milosevic
et al., 2020). Toxic leaders, which represents the dark side of leadership, are characterized by
self-centered and egoistic attitudes that are considered harmful to the motivations and
ambitions of their subordinates (Hogan and Kaiser, 2005). Toxic leadership is a kind of
leadership that creates negative inspiration and feelings in employees and severely affects
the organization (Tezcan and Uysal, 2019). In this sense, the toxic leader is the one who does
not care about the well-being of employees, behaves destructively and harmfully in a
humiliating, belittling and scolding manner (Schmidt, 2008). Various definitions and concepts
associated with toxic leadership have described the fundamental characteristics of attitude
and behavior of a toxic leader. According to Tepper (2000, p. 178), the abusive leaders are
characterized by rudeness, favoritism, coercion, insult and disrespect of subordinates in the
public. Similarly, Ashforth (1994) describes the “bad manager” as a person who uses his/her
position and powers for personal interests and ruthlessly applies the organizational policies.
Such kind of leader prevents the initiatives, fails to perform the desired achievements,
behaves rudely and ruthlessly to his subordinates, shows disdainful behavior.
Some research studies have concluded that toxic or destructive leadership may cause
malicious reactive behaviors against the leader, increase the strain and turnover among the
employees (Erickson et al., 2015, p. 270; Harvey et al., 2007). Hogan and Kaiser (2005) have
made a clear distinction between a “good leader” and a “bad leader” concerning the work
performance of a team, group or organization. They argue that the excellent leader plays a
positive role in the welfare of the employees, in direct contrast to a bad leader who may cause
a decreased quality of life for everyone in the organization. Hight et al. (2019) have determined
the six attributes of a lousy manager: “unprofessional, autocratic management style, poor
leadership skills, unethical, poor operational and technical skills, and poor decision and
delegation skills”. Similarly, Schmidt (2008) suggested five dimensions, including the abusive
supervision, the authoritarian leader, the narcissistic leader, self-promotion and the
unpredictable leader as the hallmark of toxic leadership. These dimensions are
significantly predictive of employee outputs, such as the intention to leave and job
satisfaction.

2.2 Organizational justice

Organizational justice has a positive functionality for both employees and organizations. The
perception of a high level of fairness in an organization ensures increased trust, commitment,
performance, organizational citizenship behavior, customer satisfaction and reduced
conflicts (Cropanzano et al., 2007). Niehoff and Moorman (1993) have classified the
perception of organizational justice in the employees regarding fair distribution of outcomes,
the fairness of business processes and interaction between the employee and the manager.
Organizational justice is an individual’s assessment of the ethical behavior and practices
of management in an organization (Cropanzano et al., 2007). From this point of view, the
employee evaluates the level of justice in the organizations. Organizational justice means the
degree to which work procedures, interactions and outcomes are perceived to be fair by
employees (Baldwin, 2006). These perceptions can affect the attitude and behavior of
employees, the success of an organization and employee’s performance in either positive or
negative way (Xu et al., 2015). Unfair or unjust practices in an organization, including unequal
wages, assessment of employees’ performance by unrelated persons, nepotism in recruitment
and arbitrary layoffs, are perceived negatively by employees (Baldwin, 2006). Organizational
justice is evaluated in three dimensions as distributive, procedural and interactive (Baldwin,
2006; Colquitt et al., 2001; Niehoff and Moorman, 1993).
JEAS Cropanzano et al. (2007) refer to distributive justice as a fair allocation of rewards to
employees based on their contributions (equity) to ensure that each employee receives equal
compensation (equality) and is benefited for personal requirements (need). Procedural justice
refers to the perceived fairness of the decision-making process when reaching a specific
output. If the decision-making process is carried out according to the principles of justice, the
employees will perceive the output as positive or negative. Procedural justice may be more
dominant than distributive justice. Interactional justice, considered by Colquitt et al. (2001)
under the scope of procedural justice, refers to the quality of mutual personal behaviors
perceived by the employees as part of formal decision-making procedures.

2.3 Organizational silence

Organizational voice is described as the ability of an organization’s employees to express
their views and ideas about specific issues and problems for the benefit of the organization.
On the other hand, organizational silence refers to employees withholding their opinions,
suggestions, ideas and knowledge about work, intentionally and willingly, and remaining
silent in organizational problems (Morrison and Milliken, 2000; van Dyne et al., 2003; Song
et al., 2017). There are many reasons behind the silent and withholding behavior in
organizations. The very first and foremost reason is the apprehension of negative
consequences such as fear of harming a relationship, feeling self-neglect, punishment or
revenge and creating a negative impression on others (Milliken et al., 2003). Other reasons
include lack of personal skills and experience, unsupported organizational policies or feeble
and weak relations with the top management.
van Dyne et al. (2003, p. 1362) explained the three dimensions of organizational silence that
are acquiescent, defensive and pro-social silence. In acquiescent silence, the employee
deliberately withholds his/her opinions and never shares ideas in the organization. By
contrast, in defensive silence, the employee does not reveal the problems of the organization
due to fear and ignores these problems to protect him/herself. Prosocial silence refers to
keeping and protecting private information based on social cooperation for the benefit of the
organization.

3. Hypotheses
We developed several hypotheses to test the impact of toxic leadership on the intention to
leave the organization, based on previous related literature. Linstead et al. (2014) examined
the dark side of the organization in two perspectives, which are employee’s perspective (e.g.
physical and psychological violence, alcohol abuse) and organization’s perspective (e.g. the
intention to leave, inappropriate managers behavior that lead more organizational cost). The
present study examines the subject from an organizational perspective. According to Perreira
and Berta’s (2016) proposition for the behavior of the health-care staff, positive (constructive
extra-role behaviors) to negative (destructive deviant behaviors) behaviors are primary
affected by the attitudes of the manager. Turnley and Feldman (1999) have found that
employees may display four different behavioral changes against unfair practices in the
workplace, which are turnover, negligence, raising voices and lack of loyalty and
commitment to their organization. On the other hand, Skarlicki et al. (1999) suggest that
manager’s unfair, destructive and punitive behaviors in the workplace reinforce negative
behaviors in employees.
Several studies indicate that the silence of the employees who exhibit less positive
behaviors in the organizations related to toxic leadership (Duan et al., 2010; Wang and Jiang,
2015; Song et al., 2017). Duan et al. (2010) state that managers’ unfair approaches to
organizational justice result yield two different negative behaviors: silence and retaliation.
For instance, it is revealed that abusive supervision significantly reduces the voice and Impact of toxic
silence of the employees and mediated by interactional justice (Wang and Jiang, 2015). leadership
Similarly, another study on the prevalence of nosocomial infections among patients in
Finnish hospitals found the perception of injustice and mistrust in task distribution of
health-care workers associated with the spread of nosocomial diseases among patients twice
as high (Virtanen and Elovainio, 2018). These findings indicate that poor leadership and
mistrust can lead to increased stress and indifference among health-care workers who do not
have sufficient resources.
Many studies have found that toxic leadership impairs organizational justice (Duan et al.,
2010; Hoobler and Hu, 2013; Tepper, 2000:185; Wang and Jiang, 2015) and bad managers are
responsible for injustice within the organization. In response to the unfair situation in an
organization, the organizational commitment, citizenship behaviors, job satisfaction and
performances of the employees decrease, leading to turnover intensions (Colquitt et al., 2001).
H1. Toxic leadership negatively affects organizational justice.
According to Song et al. (2017), the manager’s destructive behaviors and lack of openness to
his/her subordinates push employees to remain silent to be secure and safe. Gao et al. (2011)
found a positive relationship between the voice of employees and their trust in the manager.
They found that the managers’ behaviors, such as informing the employees, involving them
decision-making process and coaching them increase their reliability, and make the opinions
of employees more optimistic about them. Wang and Jiang (2015) found that abusive
supervision negatively affects the views of the employees and results in organizational
silence (Xu et al., 2015).
H2. Toxic leadership positively affects organizational silence.
In many studies, employees’ perceptions of organizational justice have been found to be
negatively associated with organizational silence (Huang and Huang, 2016; Song et al.,
2017; Whiteside and Barclay, 2013). Also, Wang and Jiang (2015) have proved a positive
relationship between employee voice and interactional justice. Specifically, Whiteside and
Barclay (2013) found that acquiescent silence has a partial mediation role in the
relationship between overall justice perception and emotional exhaustion, physical and
psychological withdrawal and performance. Although acquiescent silence has similar
correlations, it has no mediating role in the relationship between justice perception and
understanding of the workers. The acquiescent silence leads to physical and psychological
withdrawal attitudes, as the employees are unable to cope with distracting ideas due to the
environment full of stress and strains. This situation further leads to the thoughts of
resignation and leaving the job. Such kind of physical and psychological withdrawal can
be observed more significantly in the case of Turkey, where power distance is more visible.
Hofstede (1991) argues that people living in this kind of cultural environment are not likely
to express their concerns freely. The employees cannot change organizational policies and
are, therefore, more likely to accept the system instead of contradicting the norms and
values.
H3. Organizational justice negatively affects organizational silence.
Instead of exhibiting deviant behaviors directly against the organization, disengaged
employees show less job performance due to their stress-occupied minds (Hight et al., 2019).
Bies and Tripp (2002) stated that employees feel anxiety and fear of the realization of the
abusive attitude of the supervisors. However, employees cannot make the decision of leaving
the organization due to many domestic reasons, but they develop a strong urge to quit the job,
which further affects their job performance (Kahn, 1990). Tepper (2000, p. 186) explained
that “the subordinates whose supervisors were more abusive reported higher turnover. . .”.
JEAS Also, the study of Burris et al. (2008), using Tepper’s abusive supervision scale, found that
abusive supervision significant affects psychological detachment.
H4. Toxic leadership positively affects the intention to leave.
Elçi et al. (2014) found that organizational silence and mobbing significantly affect the
intention to leave and stated that mobbing is the partial mediator in the relationship between
organizational silence and the intention to leave. Caylak and Altuntas (2017) found that
organizational silence and organizational cynicism are found to increase the intention to quit
the job in nurses working in a university hospital in Turkey.
H5. Organizational silence positively affects the intention to leave.
The intention to stay in organizations is found significantly related to the interaction between
employees and the manager (interactional justice) is based on mutual confidence (Griffin,
2010). According to Hassan (2002), procedural and distributive justice in an organization may
lead to the intention to leave. In addition to these two dimensions, Nadiri and Tanova (2010:
37) stated that interactional justice also has negative consequences for turnover. In a meta-
analysis, Colquitt et al. (2001) detected that all dimensions of justice are positively related to
the job retraction.
H6. Organizational justice negatively affects the intention to leave.
Tepper (2000, p. 184) found that organizational justice has a mediating role in the relationship
between voluntary turnover and abusive supervision. Burris et al. (2008) found that
detachment has a mediating role in the relationship between abusive leadership and the voice
of employees, which is a verbal communication for the improvement of organizational
activities rather than criticism. On the contrary, it has been previously mentioned elsewhere
that employees prefer to remain silent and think of leaving the job (Elçi et al., 2014) as the poor
practices of the manager increase (Xu et al., 2015, p. 765; Song et al., 2017). Therefore, it can be
interpreted that organizational silence and justice are the mediators in the relationship
between toxic leadership and intention to leave.
H7. An increase in toxic leadership results in a decrease in perceptions of organizational
justice, which, in turn, leads to an increase in intentions to leave.
H8. An increase in toxic leadership results in an increase in perceptions of organizational
silence, which, in turn, leads to an increase in intentions to leave.
Control variables related to toxic leadership, organizational justice, organizational silence
and intention to leave have been involved in this study, including gender, age, marital status,
occupation, education, employment status (permanent or contractual employees) and work
experience.

4. Research method
4.1 Model and analysis methods
The present study aims to analyze the relationships between toxic leadership, organizational
justice, organizational silence and intent to leave work. The exogenous variable is toxic
leadership is used as the independent variable, while endogenous variables of organizational
justice, organizational silence and intention to leave are used as dependent variables. The
study is based on the assumption that toxic leadership has a negative effect on the employees.
The manager’s negative attitudes toward employees are thought to increase organizational
silence and the intention to leave the job. A bad manager is found to maximize his/her own
interests, behave unethically and his/her authoritarian style leads to unfair practices in the
organization. Thus, the attitude and behavior of a toxic manager negatively affect Impact of toxic
organizational justice, silence and intention to leave. leadership
A manager’s understanding and conduct of justice determine how employees express
themselves within the organization by shaping their perceptions about the organization and
the manager. Narcissistic, destructive and manipulative toxic leadership characteristics may
lead to the perception of injustice (Duan et al., 2010; Hoobler and Hu, 2013; Tepper, 2000;
Wang and Jiang, 2015), organizational silence (Huang and Huang, 2016; Song et al., 2017) and
the increase intention to leave (Schmidt, 2008). In this context, the proposed model is shown in
Figure 1.
Path analysis was applied using the structural equation model to test the accuracy of the
proposed model. The survey technique was used to determine the relationships between the
concepts described in the model using Likert scales with the highest structural compatibility.
Responses were rated on a five-point Likert scale from “strongly disagree” to “strongly
agree”. Confirmatory factor analysis (CFA) was performed for structural validity, while
threshold values were used within the accepted limits in the literature (Hair et al., 2006): for the
good fitness statistics in structural equation modeling (SEM), the chi-square goodness of fit
(χ 2 (CMIN)/df ≤ 3), the comparative fit index (CFI ≥ 0.92), the root mean square error of
approximation (RMSEA ≥ 0.09) and the standardized root mean square residual
(SRMR ≥ 0.08) were used. Composite reliability (CR ≥ 0.70), the average variance
extracted (AVE ≥ 0.50), Cronbach’s alpha (CA ≥ 0.70), factor loading (≤0.40) and larger value
of the square root of AVE than inter-construct correlations were used for reliability and
validity.

4.2 Measurement
The questionnaire consists of five parts. The first part includes control variables of gender,
marital status, educational level, age, work experience, occupation and employment status
(permanent and contractual employees). To test the model, four related concepts were

control variables:
gender, marital status, age, education, occupation, experience, employment status

Organizational
silence
H5+
H2+
H8

toxic turnover
leadership intention
H4+

H3 –
H7
H1 –
H6 –

Organizational
justice Figure 1.
The proposed
research model
Note(s): Mediation role is represented by the dashed lines
JEAS measured by using scales with high validity and reliability. The scales were translated from
English to Turkish by the authors of the study, while language corrections were made by a
faculty member with expertise the Turkish Language. Furthermore, the scales were
retranslated to English by an expert from English philology to check the originality of the
contents.
The second part of the questionnaire comprises the questions to measure the perception of
employees about toxic leadership. Toxic Leadership Scale developed by Schmidt (2008) was
used in the present study. This scale consists of five dimensions, with 30 items in total. Each
dimension has different items associated with negative leadership. It includes seven items for
an abusive leader, six items for an authoritarian leader, five items for a narcissist leader, five
€ et al. (2017) tested
items for a self-promotion leader and seven items for unpredictability. Ozer
the validity and reliability of the Toxic Leadership Scale of Schmidt (2008) on health-care
workers in Turkey. Schmidt (2008) found that the reliability of scale dimensions is between
0.88 and 0.97. The values of reliability of the dimensions were found 0.94, 0.86, 0.95, 0.95 and
0.97, respectively, in the present study.
The organizational justice scale developed by Moorman (1991) was used in the third part
of the questionnaire. The scale has a total of 20 items, which are categorized in three
dimensions of distributive (five items), formal procedures (six items) and interactional justice
(nine items). Moorman (1991) found that the reliability of the scale ranges from 0.93 to 0.94.
The reliabilities of the dimensions are 0.79, 0.88 and 0.96, respectively, in the present study.
The organizational silence scale developed by van Dyne et al. (2003) was used in the fourth
part of the questionnaire. This scale has three dimensions: acquiescent silence, defensive
silence, prosocial silence (silence for organization). Each dimension has five items, with a total
of 15 items. van Dyne et al. (2003) found the reliability of the scale to be ranging from 0.82 to
0.90. In this study, the alpha value was found 0.82 to 0.93, and the overall scale was 0.86.
The last part of the questionnaire consists of four items from the scale of “intention to
leave” tested by Ramesh (2007), in which three items were adopted from O’Reilly et al. (1991)
and one from Hom et al. (1984). Ramesh (2007) found the alpha value is as 0.94 for the US
sample and as 0.89 for the Indian sample. The alpha value in the study was calculated as 0.91.

4.3 Sample and the research context

The participants of the present study include nurses, medical assistants (to doctors), medical
clerks (such as data recording, work on the front line of the hospital) and health technicians
(such as aesthesia, biology and radiology) in a research and teaching hospital. The survey
conducted with 347 nurses, 169 medical clerks, 93 medical assistants and 71 health
technicians. There were 360 permanents and 320 contracted employees, making a total of 680
participants. Hospitals in Turkey are divided into three types: public, university and private
hospitals. While permanent employees work in public and university hospitals, contracted
employees work in all three types of hospitals. The contractual employees of the university
hospitals, which are public institutions, are employed for one year, and the contract may be
renewed at the end of the contractual period.

4.4 Reliability and validity

All of the variables have skewness and kurtosis values between 1.88 and 2.18 , making the
distribution of data normal (West et al., 1995, p. 454). The variance inflation factor (VIF) and
tolerance values of the variables for multicollinearity were examined, and the VIF value was
found to be below 5, with a tolerance value of 1. Moreover, correlations between the variables
are not found to be above 0.85 (Hair et al., 2006). The values of Durbin–Watson were between
1.5 and 2.5, while no autocorrelation was present. Respondents’ names were not asked in the
questionnaires to avoid any common method variance bias (Podsakoff et al., 2003). Besides,
all scales were checked by Harman’s single-factor test (Podsakoff and Organ, 1986) in a single Impact of toxic
pool. The exploratory factor analysis (EFA) only explained 24.132% of the total variance, so it leadership
was seen that all of the scales were not aggregated in one factor, showing that there was no
common method variance bias.
Maximum likelihood was applied as a method for CFA to determine whether scale items
meet the variable or not. According to the first-level CFA result, the SEM good fit indexes
were not acceptable: χ 2(CMIN) 5 6,300.30; df 5 2,211; χ 2(CMIN)/df 5 2.85 (p 5 0.000);
CFI 5 0.838; RMSEA 5 0.071; SRMR 5 0.065. Items with low factor loading, AVE and CR
values were excluded from the analysis (13 items in total). Similarly, the items that were
highly associated with a different latent variable were removed from the analysis.
Co-variances were drawn between the items with high associations belonging to the same
scale theoretically. Construct validity and reliability values were found at an acceptable range
of 0.482–0.939 for factor loadings, 0.56 to 0.81 for AVE; 0.83 to 97 for CR and 0.81 to 0.97 for
alpha (Table 1).
A second-level CFA was conducted to determine whether the scale dimensions were
constructed under the main variables. As a result, toxic leadership, following the theoretical
literature (Schmidt, 2008) and organizational justice (Moorman, 1991) was integrated into the
upper factors. However, according to the second-level CFA results, the sub-dimensions of
organizational silence were not combined in one factor due to low factor loadings, AVE and
CR values. As result, the second-level CFA model yielded good fit indices:
χ 2(CMIN) 5 2,931.61; df 5 1,436; χ 2(CMIN)/df 5 2.042 (p 5 0.000); CFI 5 0.927;
RMSEA 5 0.053; SRMR 5 0.052. The values for construct validity and reliability were in an
acceptable range of 0.692–0.981 for factor loadings, 0.71 and 0.87 for AVE, 0.88 and 0.97 for
CR, 0.948 and 0.982 for alpha of organizational justice and toxic leadership, respectively
(Table 1). The results of the comparison of the square root of AVE and inter-construct
correlations for discriminant validity (Table 2) were found satisfactory. The scales and items
were then subjected to SEM analysis for the testing of hypotheses.

5. Findings
5.1 Descriptive statistics of demographics
The questionnaires were sent to all the employees, from which 403 returned, making the
response rate 59.27%. Another 34 questionnaires were excluded from the analysis because of
ambiguous answers to more than 20% of the questions/items. Further two questionnaires
with standard deviations of less than 0.50 of the scales were also excluded from the analysis
because of unreliable answers. Moreover, the extreme values of responses, arising from
outliers or unengaged respondents were also checked. At the end, a total of 367
questionnaires were analyzed to generate the results.
The respondents were mostly female (68%), having at least a bachelor’s degree (47%) and
having occupation of nursing (43%), one-third contracted and more than half married (58%).
The age of the respondents ranged from 18 to 49, with a mean age of 29.64 (±29.54). Their
mean experience in their profession was 84.14 (±72.01) months (Table 2).
It is seen from Table 3 that toxic leadership has a weak negative relationship with
organizational justice (r 5 0.337; p ≤ 0.01) but a weak positive relationship with acquiescent
silence (r 5 0.251; p ≤ 0.01), defensive silence (r 5 0.197; p ≤ 0.01) and prosocial silence
(r 5 0.145; p ≤ 0.01). However, it is found to have a moderate positive relationship with
intention to leave (r 5 0.538; p ≤ 0.01). It statistically appears that organizational justice is
negatively but very weakly related to acquiescent silence only. Also, organizational justice is
found to have a moderate to low relationship with intention to leave. Intention to leave has a
positive relationship with acquiescent silence (r 5 0.265; p ≤ 0.01) and prosocial silence
(r 5 0.124; p ≤ 0.05) but no association with defensive silence.
 JEAS

Table 1.

resulting from
CFA (N 5 367)
Reliabilities and
validities of the scales
First-level CFA Second-level CFA
Scales AVE CR Alpha Factor loadings AVE CR Alpha

Intention to leave (4 items, turint) 0.72 0.91 0.91 – – – –

Organizational justice (orjus) Distributive justice (3 items) 0.62 0.83 0.83 0.692 0.71 0.88 0.948
Formal procedures (5 items) 0.56 0.86 0.86 0.893
Interactional justice (8 items) 0.72 0.95 0.96 0.916
Acquiescent silence (4 items, orsila) 0.56 0.83 0.81 – – – –
Defensive silence (3 items, orsild) 0.67 0.86 0.86 –
Prosocial Silence (4 items, orsilp) 0.64 0.88 0.90 –
Toxic leadership (toxlead) Abusive supervision (7 items) 0.69 0.94 0.94 0.885 0.87 0.97 0.982
Authoritarian leadership (3 items) 0.73 0.89 0.89 0.919
Narcissism (4 items) 0.81 0.94 0.94 0.937
Self-promotion (4 items) 0.81 0.94 0.94 0.981
Unpredictability (7 items) 0.81 0.97 0.97 0.942
 Gender (%) Marital status (%) Education (%)
Impact of toxic
High school or Vocational Graduated and leadership
Female Male Married Single below school above

250 (68.1) 117 (31.9) 214 (58.3) 153 (41.7) 84 (22.9) 111 (30.2) 172 (46.9)

Experience
Status (%) Occupation (%) (month) Age
Medical Medical Health Mean 84.14 29.64
Permanent Contract Nurse assistant clerk technician (SD) (72.01) (29.54) Table 2.
Descriptive statistics of
128 (34.9) 239 (65.1) 159 (43.3) 56 (15.3) 99 (27.0) 53 (14.4) Min.- 1–361 18–49 demographic
Max variables (N 5 367)

5.2 Path analysis

Paths were drawn between latent variables to test the proposed model. As a result of the
second-level CFA, three dimensions of organizational silence were added directly to the model
to provide structural validity. In this context, toxic leadership was found to positive affect
acquiescent silence, defensive silence, prosocial silence and intention to leave positively, while
organizational justice is negatively influenced. At the same time, while acquiescent silence,
defensive silence and prosocial silence have a negative effect on organizational justice, they
have a positive effect on the intention to leave. Finally, organizational justice was found to
have a negative effect on the intention to leave. Gender, marital status, age, education
occupation, work experience and employment status were added to the model as control
variables as covariates and paths. The model result shows that the threshold values were
met: χ 2(CMIN) 5 3,455.291; df 5 1,789; χ 2(CMIN)/df 5 1.931 (p 5 0.0001); CFI 5 0.922;
RMSEA 5 0.050; and SRMR 5 0.052. In the analysis, some paths and variances were deleted
from the model because they had insignificant values. After removing insignificant paths and
covariates related to the control variables, the results of the analysis revealed the effects of
gender on prosocial silence (β 5 0.113; p 5 0.035), organizational justice (β 5 0.109;
p 5 0.039) and intention to leave (β 5 0.108; p 5 0.014), the effect of occupation on prosocial
silence (β 5 0.155; p 5 0.004) and intention to leave (β 5 0.228; p ≤ 0.001), the effect of
education on organizational justice (β 5 0.145; p 5 0.007) and intention to leave (β 5 0.105;
p 5 0.020), the effect of employment status on acquiescent silence (β 5 0.136; p 5 0.011) and
defensive silence (β 5 0.158; p 5 0.005), the effect of work experience on acquiescent silence
(β 5 0.155; p 5 0.003) and defensive silence (β 5 0.205; p 5 0.010) and the effect of age on
defensive silence (β 5 0.361; p ≤ 0.001) (Table 4).
After removing insignificant paths of latent variables, the model yielded good fit indexes:
χ 2(CMIN) 5 3,427.775; df 5 1,771; χ 2(CMIN)/df 5 1.936 (p 5 0.000); CFI 5 0.922;
RMSEA 5 0.051 and SRMR 5 0.0582. Toxic leadership was found to positively affect
acquiescent silence (β 5 0.279; p ≤ 0.0001), defensive silence (β 5 0.151; p 5 0.007), prosocial
silence (β 5 0.288; p ≤ 0.0001) (H2 partially accepted) and intention to leave (β 5 0.417;
p ≤ 0.0001) (H4 accepted) but negatively affect organizational justice (β 5 0.407; p ≤ 0.0001)
(H1 accepted). H2 was partially accepted because the dimensions of organizational silence
were not accumulated under a scale that resulted in the second CFA. Organizational justice
was found to affect prosocial silence (β 5 0.147; p 5 0.022) positively (H3 rejected). Only
acquiescent silence from the dimension of organizational silence was found to positively
affect the intention to leave (β 5 0.158; p 5 0.001) (H5 partially accepted). Intention to leave
was found to be negatively affected by organizational justice (β 5 0.224; p ≤ 0.0001)
(H6 accepted).
 JEAS

Table 3.
Correlations and
square root of AVE
x (s) Age Experience Toxlead Orjus Orsila Orsild Orsilp Turint

Age 29.64 (±5.96)

Experience 84.14 (±62.57) 0.73**
Toxlead 3.05 (±1.15) 0.11* 0.13* 0.93
Orjus 2.52 (±0.9) 0.05 0.11* 0.34** 0.84
Orsila 2.76 (±1) 0.08 0.06 0.25** -0.11* 0.75
** ** **
Orsild 3.76 (±1.1) 0.15 0.17 0.20 0.05 0.25** 0.82
Orsilp 2.29 (±1.03) 0.18** 0.04 0.15** 0.07 0.33** 0.06 0.80
Turint 2.98 (±1.26) 0.01 0.08 0.54** 0.41** 0.27** 0.08 0.12* 0.85
Note(s): Toxlead 5 toxic leadership; orjus 5 organizational justice; orsila 5 acquiescent silence; orsild 5 defensive silence; orsilp 5 prosocial silence; turint 5 intention
to leave. Square root of AVE is shown at diagonal as italic. *p ≤ 0.05; **p ≤ 0.01; n 5 367
 Unstandardized Standardized
Impact of toxic
Paths Estimate SE CR P Estimate leadership
Orjus ← Toxlead 0.278 0.045 6.144 *** 0.407
Orsila ← Toxlead 0.293 0.062 4.74 *** 0.279
Orsild ← Toxlead 0.154 0.057 2.719 0.007 0.151
Orsilp ← Toxlead 0.363 0.079 4.58 *** 0.288
Turint ← Toxlead 0.578 0.08 7.257 *** 0.417
Orsilp ← Orjus 0.272 0.118 2.299 0.022 0.147
Turint ← Orjus 0.455 0.111 4.097 *** 0.224
Turint ← Orsila 0.208 0.064 3.271 0.001 0.158
Turint ← Gender 0.277 0.112 2.466 0.014 0.108
Orsilp ← Gender 0.264 0.125 2.105 0.035 0.113
Orjus ← Gender 0.137 0.066 2.068 0.039 0.109
orjus ← Education 0.106 0.039 2.721 0.007 0.145
Turint ← Education 0.155 0.067 2.326 0.02 0.105
Orsila ← Status 0.261 0.103 2.531 0.011 0.136
Orsild ← Status 0.292 0.103 2.829 0.005 0.158
Orsilp ← Occupation 0.15 0.052 2.902 0.004 0.155
Turint ← Occupation 0.243 0.047 5.149 *** 0.228
Orsilp ← Experience 0.003 0.001 2.956 0.003 0.155 Table 4.
Orsild ← Experience 0.003 0.001 2.59 0.01 0.205 The regression weights
Orsild ← Age 0.053 0.012 4.528 *** 0.361 of the estimated model

5.3 Mediation effects

The model was divided into two parts as organizational silence and organizational justice to
test the mediating effects on the relationship between toxic leadership and intention to leave.
Three separate analyses for the dimensions of organizational silence were required for the
mediator effects due to the absence of structural validity of organizational silence. According
to the model of Baron and Kenny (1986), which examined the mediation effect, the
independent variable (toxic leadership) must have a significant impact on the variable of
mediating role (organizational silence and organizational justice) having a considerable effect
on the dependent variable (intention to leave) too. The mediation effect was performed only
for acquiescent silence, as the effect of defensive and prosocial silence on the intention to leave
was not significant. Sobel test (Sobel, 1982) was used to test the significance of mediation.
As shown in Table 5, the partial mediation of organizational justice (H7 accepted) and
acquiescent silence (H8 accepted) in the effect of toxic leadership on the intention to leave was
found significant at 0.001 level.

5.4 Testing multi-group differences and moderation effects

Although not included in the hypotheses, multi-group analyses were conducted to check
whether the model differs based on demographic factors. Also, the chi-square difference
analysis was performed to test whether the differences between the models was significant in
terms of demographic variables. The demographic variables considered as control variables
were removed from the analysis to avoid positive definite errors. The significance of the
group differences between the unconstrained and the fully constrained chi-square values was
examined in the overall model. No significant differences between groups were found in the
model. However, the significance of the differences between groups at the path level was
determined (Table 6).
The differences between the groups were examined for each path on the basis of the
critical ratios. It was found that the differences were based on gender, employment status and
JEAS marital status (Table 6). We could not conduct any analysis of education and occupation due
to the low sample size for each group. Toxic leadership (z 5 2.59; p < 0.001) has a more
significant effect on the intention to leave in males (β 5 0.66; p < 0.001) than females (β 5 0.31;
p > 0.001) according to standardized beta value. Another significant finding is that unmarried
employees scored higher scores (β 5 0.41; p < 0.001) than married ones (β 5 0.11; p < 0.15) in
terms of effects of toxic leadership on prosocial silence (z 5 2.68; p < 0.001).
According to Table 6, toxic leadership (z 5 1.65; p < 0.1) has a more significant effect on
acquiescent silence in permanent employees (β 5 0.39; p < 0.001) than contractual employees
(β 5 0.22; p > 0.05). Figure 2 shows these differences between employment statuses more
clearly. The increase in toxic leadership in an organization increases acquiescent silence in
more permanent staff than contractual staff. This means that permanent staff confronts more
to toxic leadership compared to the contracted staff, and they make less ideas and
suggestions for resolving the existing issues in the organization.

6. Discussion
Five of the six hypotheses mentioned in the model were confirmed in the path analysis with
SEM. As employees’ negative feelings toward the toxic manager increase, the perception of
justice toward the practices of the organization decreases (Duan et al., 2010; Hoobler and Hu,
2013; Tepper, 2000; Wang and Jiang, 2015). At the same time, employees accept the manager’s
practices, and they keep silent for the sake of their organization or colleagues or to protect
themselves (Duan et al., 2010; Wang and Jiang, 2015; Xu et al., 2015; Goldman, 2006). As a
result, the employee intents to leave the job. Besides, the employee considers leaving his/her
position after realization the absence of justice in the organization and remains silent as
he/she accepts the practices of the organization.
Despite the results of the analysis that confirm the hypotheses, the claim of increased
organizational silence in response to the increased perception of injustice within an
organization (Huang and Huang, 2016; Song et al., 2017; Whiteside and Barclay, 2013) does
not appear to be significant due to two reasons. First, there is no construct under the name of
organizational silence in CFA in the structure validity of the scales, and each dimension of
silence remained independent. Only prosocial silence from these dimensions was found to
have a significant relationship with organizational justice. Second, although the effect of
organizational justice affects the prosocial silence substantially, the effect was found positive,
while the predicted impact was negative. Prosocial silence is different from the other two
types of silences. It has a positive relationship with justice because, in prosocial silence,
employees give more consideration to the organization’s reputation and avoid becoming
harmful to their colleagues for their protection. According to prosocial silence, employees
remain silent for the sake of the prosperity of the organization and work for the benefit of it
(Huang et al., 2005). If an employee feels committed to the organization and the colleagues

IV M DV Beta (SE) β Z S.E. p-value

Toxlead – Turint 0.757 (0.096) 0.546 – –

Toxlead Orjus – –0.278 (0.045) –0.407 3.445 0.0378 0.0006
– Orjus Turint –0.469 (0.113) –0.231
Toxlead – Turint 0.629 (0.080) 0.455
Toxlead Orsila – 0.290 (0.062) 0.275 2.726 0.023 0.0064
Table 5. – Orsila Turint 0.218 (0.065) 0.165
Testing of mediating Toxlead – Turint 0.699 (0.080) 0.501
model with Sobel test Note(s): The calculations were produced by using Preacher and Leonardelli’s (2001) web page
 Gender Employee status Marital status
Paths Female Male z-score Perm Cont z-score Married Unmarried z-score

Toxlead → orjus –0.25*** –0.37*** 1.06 –0.20*** –0.31*** 1.04 –0.34*** –0.20*** 1.50
Toxlead → orsila 0.30*** 0.22** –0.52 0.44*** 0.22*** 1.65* 0.33*** 0.23** –0.81
Toxlead → orsild Not supported for both 0.21** 0.14 0.62 0.10 0.24** 1.12
Toxlead → orsilp 0.27*** 0.36*** 0.58 0.33*** 0.30*** 0.16 0.13 0.54*** 2.68***
Toxlead → turint 0.43*** 0.93*** 2.59*** 0.40*** 0.60*** 1.25 0.58*** 0.58*** 0.05
Orjus → turint –0.60*** –0.31** 1.36 –0.29** –0.60*** 1.33 –0.45*** –0.72*** 1.05
Orsila → turint 0.22** 0.11 –0.90 0.34*** 0.19** 1.20 0.16** 0.24** 0.54
2
Overall (χ /df) 64.318/108 88.804/114 39.521/114
Note(s): Insignificant paths for all groups have not been shown. ***p-value < 0.01; **p-value < 0.05; *p-value < 0.1
leadership
Impact of toxic

estimates/Z-scores
(unstandardized

with critical ratios)

Table 6.
Multi-group analysis
JEAS 3.2 status
permanant
Contract
3.0

2.8

acquiescent silence 2.5

2.3

2.1

1.8
Figure 2.
–2.1 –1.4 –0.7 0.0 0.6 1.3 2.0
Moderation effects of
employment status toxic leadership
(centered)

he/she works with, the employee will not act as the whistle-blower of the unfair practices of
the organization to protect it. Indeed, Uslu and Aktas (2015) uncovered a positive relationship
between procedural justice and prosocial silence in their study on nurses working in hospitals
of Turkey. Our results were similar to those reported by Uslu and Aktas (2015) because they
reflect Turkey’s cultural values. The toxic leadership was found to be positively associated
with all three dimensions of organizational silence in the study. By contrast, only prosocial
silence was identified to relate organizational justice due to the employee’s dependence on the
power of the manager. Hence, Tangirala and Ramanujam (2008) found that the presence of
high-status supervisors creates anxiety among health-care workers, thereby making them
quieter. Wang and Jiang (2015) explained that in case of an increase in abusive leadership, the
decrease in the employee’s prosocial voice and silence tends to keep the relationship balanced
due to the power of the manager. The subordinates tend to obey the decisions of the managers
because of the established subordinate–superior relationship and asymmetrical power in
organizations, especially in the Asian culture. Employees’ negative interactions with their
managers in the workplace negatively affect their tenure and promotion in the organization.
Another important finding of the present study is the difference in terms of silence
between permanent and contractual employees. Contractual employees (2.84 ± 0.98) show
more acquiescence with negative practices of management and are more silent to protect
themselves (t 5 2.03; p ≤ 0.05) than permanent staff (2.62 ± 1.02). Therefore, contracted
employees remain more silent about negative practices of the management because they
work for an organization that has employed them for a short term with transitional services
agreement. In contrast to what Rousseau and Wade-Benzoni (1995) proposed, McDonald and
Makin (2000) found that permanent employees have more affective and normative
commitment to the organization and has higher job satisfaction than that of temporary
employees. It is argued that a permanent employee has a higher relational contract because of
dedication and job satisfaction. However, a temporary employee has a transactional contract
due to the underlining economic factors of the contract. According to McDonald and Makin
(2000), this difference is based on the phenomenon of “anticipatory socialization” that is
described as “the observance and commitment to the norms, symbols and rituals of desirable
groups than is often higher among those just outside, but wishing to join, the groups than it is
among established members” (p. 89). This rationalization also applies to this study. Despite
this finding, acquiescence silence increases faster in the permanent staff who are more Impact of toxic
confronted with the toxic manager. Permanent staff often ignore these problems because they leadership
are supposed to have a long business relationship with the toxic manager, while contractual
staff are more concerned about the future of their job. Consequently, contracted staff make
more effort than permanent staff to keep the management satisfied (Engellandt and Riphahn,
2005). Therefore, even if a manager is toxic, we can expect that contracted staff will remain
more silent as compared the permanent staff.

7. Implications, limitations, future research and conclusion

Although the present study is conducted only with the employees of a hospital with some
limitations and constraints, the results are quite important. The negative consequences of
toxic leadership on organizational justice, the self-expression of the employees and the
intention to leave the job make the study important in the academic and practical fields.
Ensuring interactional justice and organizational attribution is considered important in
reducing the effects of abusive supervisor on employees’ silence (Wang and Jiang, 2015). In
this respect, organizations should be very careful in selection and promotion of top managers/
supervisors to avoid toxic work environment in an era where competition is intensified and
human rights sensitivity is increasing.
There is heavy workload and interdependence of hospital works, which may threaten
human health (Tangirala and Ramanujam, 2008). The health-care workers may prefer to
remain silent about such faulty practices due to the pressure from authorities, which can
deteriorate the health-care system (Maxfield et al., 2005). Therefore, employees should be
encouraged to express their opinions and thoughts to maintain the quality standards of
services (Tangirala and Ramanujam, 2008). Besides, attention should be paid to the selection
of managers to run the health-care system efficiently, ensuring the safety of patient.
Otherwise, as long as there is silence, mistakes continue unavoidably with decline in morale
and productivity (Bayın et al., 2015, p. 252). Therefore, it is argued that organizational
commitment and sense of belonging of health-care workers depend on a well-chosen
manager. In this sense, this study provides new and useful information on what health-care
managers can do to retain employees.
The research has several constraints of context, time and capacity to encompass all the
parameters of the toxic leadership and therefore cannot be generalized. More context-specific
studies are required to explore different dimensions of toxic leadership. In this study, the
questionnaire technique was used via the drop–collect technique. There are some
disadvantages of this technique, which is a limitation of this study. Despite the significant
findings of the present study, there is enough room for further explanation of several issues.
The concept of organizational justice is explored only in the context of toxic leadership, while
there are other factors that may lead to injustice within an organization. Therefore, future
research is possible with different perspectives on organizational justice.

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About the authors

Dr Metin Reyhanoglu is an Associate Professor in the Department of Business Administration at the
Hatay Mustafa Kemal University, Hatay, south of Turkey, where he has been a faculty member since
2008. Reyhanoglu completed his PhD at the Faculty of Political Sciences, Ankara University, graduated
from Mustafa Kemal University and his undergraduate studies at the Inonu University. He teaches
lectures mainly in the area of management and organization since 2008; examples of his lectures are
entrepreneurship and small and medium-sized enterprises (SMEs), organization theories, cross-cultural
management to undergraduate and graduate level. His research interests lie in the mean area of
organizational behavior and organizational theory. In recent years, he has focused on job embeddedness,
burnout, ambidexterity and work–family conflict. Metin Reyhanoglu is the corresponding author and
can be contacted at: reyhanoglu@gmail.com
JEAS Dr Ozden Akin is an Assistant Professor in the Department of Business Administration at the Hatay
Mustafa Kemal University, Hatay, south of Turkey, where she has been a faculty member since 2009.
Akin completed his PhD at the Faculty of Political Sciences, Ankara University, graduated from
Mustafa Kemal University and her undergraduate studies at the Mustafa Kemal University. She teaches
lectures mainly in the area of management and organization since 2012; examples of her lectures are
organizational behavior to undergraduate and graduate level. Her research interests lie in the mean area
of organizational behavior.

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