The effect of Servant Leadership on Medical Staff Unethical Pro-organizational Behavior: The role of Work Meaning and Power Distance 

The effect of Servant Leadership on Medical Staff Unethical Pro-organizational Behavior: The role of Work Meaning and Power Distance | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The effect of Servant Leadership on Medical Staff Unethical Pro-organizational Behavior: The role of Work Meaning and Power Distance Jianji Zeng, Jing Cai, Liuxiang Li, Qing Yang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6429672/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 24 Oct, 2025 Read the published version in BMC Health Services Research → Version 1 posted 10 You are reading this latest preprint version Abstract Objective: To examine the mechanism of servant leadership influence on unethical pro-organizational behavior based on social information processing theory. Methods: Convenience sampling was used to survey the medical staff of more than ten public hospitals in Guangdong and Guangxi provinces of China, 420 valid samples were recovered and the data were analyzed using validation factor analysis, descriptive statistics, multiple regression analysis, and moderated mediated effects analysis. Results: Servant leadership positively affects medical staff’s unethical pro-organizational behavior; work meaning mediates the relationship between servant leadership and medical staff’s unethical pro-organizational behavior; power distance moderates the indirect effect of servant leadership on medical staff’s unethical pro-organizational behavior through work meaning, and the higher the power distance is, the stronger that indirect impact is. Conclusion: Government authorities and hospital management need to be alert to the negative effects of servant leadership and consider the positive impact of servant leadership while also fostering correct ethical values and work codes of conduct among medical staff. In addition, communication and interaction between leaders and their subordinates should be strengthened to build high-quality superior-subordinate relationships, reduce power distance, and prevent the induction of unethical behaviors. Servant Leadership Work Meaning Unethical Pro-organizational Behavior Power Distance Figures Figure 1 Figure 2 INTRODUCTION Public attention has always focused on health and wellness organizations with hospitals at their core, the exposure of scandals in Chinese hospitals, such as that of Dr Liu Xiangfeng at the Second Xiangya Hospital of Central South University, has brought unethical behavior in hospitals to the attention of a wide range of public opinion. A survey of medical staff showed that 30% admitted that there was a problem with large prescriptions in the medical industry; 32.5% believed that there was a situation in the medical sector where patients were induced to undergo unnecessary tests, and even more than one-third admitted that there was a situation of drug abuse and so on [ 1 ]. It is generally believed that unethical behaviors are mainly actions committed by individuals to seek private gain or revenge against organizations that are against society’s moral code [ 2 ]. However, some studies have also shown that individuals commit unethical behaviors with complex motives—not necessarily for personal self-interest but possibly for organizational benefit [ 3 ]. The China National Healthcare Security Administration investigated 111 typical health insurance fraud cases between September 2018 and March 2022 [ 4 ], with medical staff orchestrating some instances to obtain health insurance funds and boost hospital revenues fraudulently. There are serious unethical behaviors in certain hospital organizations. In recent years, unethical behaviors within organizations have garnered heightened academic interest and emerged as a prominent subject of inquiry in Management Psychology. Scholars refer to persons who participate in actions that benefit the organization or other members (e.g., leaders), yet violate portions of essential core socialist values, morality, and the law as unethical pro-organizational behavior [ 5 ]. In essence, unethical pro-organizational behavior, as a specific type of unethical, combines the conflicting characteristics of both ‘pro-organizational’ and ‘unethical’ practices. Organizations frequently overlook, comply with, or even promote it under the pretense of being ‘pro-organizational’ despite its ethical dilemmas and adverse impacts on the interests of customers and other external stakeholders [ 6 ]. Ultimately, this activity may seriously influence the reputation and growth of the organization [ 7 ]. In China, traditional Confucian culture promotes the values of individual subordination to the collective, subordinates following the leader and valuing collective interests, and these may lead to pro-organizational non-ethical behaviors are not uncommon in Chinese social organizations [ 8 ], especially in public hospitals where the distance of power is high, as seems to be corroborated by the frequent cases of fraudulent insurance policies that have occurred in Chinese hospitals in recent years. Public hospitals are the primary component of China’s healthcare system, serving as protectors of public health and a crucial assurance for advancing high-quality health services. Consequently, the public hospital healthcare workforce’s growth is paramount. Therefore, examining unethical pro-organizational behavior among medical staff in public hospitals carries major theoretical and practical significance. Current literature indicates that leadership style is crucial to an individual’s unethical pro-organizational behavior, including paternalistic leadership [ 9 ], transformational leadership [ 10 ], and empowering leadership [ 11 ]. Surprisingly, there has rarely been an explicit examination of the impact of Servant leadership on subordinates’ unethical pro-organizational behavior, particularly within medical institutions. This leadership style, characterized by its supporting nature, prioritizes the interests of subordinates and emphasizes their growth and career development, making it highly esteemed by social organizations, especially hospitals. Current research on servant-leadership effectiveness primarily emphasizes its beneficial influence on employee behavior, including innovative behavior [ 12 ] and work prosperity [ 13 ]; however, this ostensibly ideal leadership style may also induce negative consequences in specific contexts, such as promoting unethical pro-organizational behavior among subordinates [ 14 ]. Examining the adverse repercussions of servant leadership is crucial as it can yield essential insights for interventions aimed at mitigating or eradicating these negative consequences while enhancing the understanding of the essence of servant leadership. Consequently, investigating the mechanisms that influence unethical pro-organizational behavior among medical staff from a servant leadership perspective holds considerable academic significance. Social information processing theory offers a theoretical framework for comprehending the unethical pro-organizational behavior of medical staff. Social information processing theory posits that the social information available to an individual offers cues that assist in interpreting the organizational environment, and varying interpretations of this environment by an individual affect their attitudes and behaviors [ 15 ]. As a result, the medical staff’s work meaning is enhanced through a deep processing process of learning, attributing, coding, and evaluating the words and actions of servant leadership. Research indicates that an individual’s work meaning can profoundly affect their organizational identity [ 16 ], which is a crucial predictor of unethical pro-organizational behavior [ 17 , 18 ]. Therefore, by synthesizing social information processing theory and the literature on unethical pro-organizational behavior, we propose that work meaning mediates the relationship between servant leadership and influencing medical staff’s unethical pro-organizational behavior. Furthermore, situational factors and personal characteristics impact individuals when processing social information, as postulated by the social information processing theory [ 15 ]. Research has demonstrated that individual characteristics serve as crucial boundary conditions in the shaping of unethical pro-organizational behavior [ 19 ]. Power distance is both an individual characteristic and an important cultural value that reflects the individual’s acceptance of job hierarchies and power differentials. It significantly influences the process and outcome of interactions between leaders and subordinates [ 20 ]. Consequently, the present study sought to ascertain the role of power distance as a moderator, thereby delineating the boundaries of the relationship between servant leadership and unethical pro-organizational behavior that benefits the organization among medical staff. In particular, the indirect effect of servant leadership on the unethical pro-organizational behavior of medical staff was found to be most pronounced at high power distance relative to low power distance. Consequently, by identifying the boundary conditions under which servant leadership influences the unethical pro-organizational behavior of medical staff, we can further comprehend the formation mechanism of unethical pro-organizational behavior based on the social information processing theory. In conclusion, this study examines the impact of servant leadership on the unethical pro-organizational behavior of medical staff, while also examining the mediating role of work meaning and the moderating role of power distance, all within the framework of social information processing theory. This study conducts an in-depth exploration of the internal psychological mechanism that forms the unethical pro-organizational behavior of medical staff. The objective is to clarify the triggering mechanism and provide useful ideas for relevant governmental departments and hospital organizations to intervene in this unethical pro-organizational behavior. Research hypotheses Servant Leadership and Unethical Pro-organizational Behavior of Medical Staff Servant leadership advocates that leaders act as servants and put the interests of their subordinates first [21]. Servant leadership assists organizations in fostering a laid-back work atmosphere that fosters a sense of dedication to the organization, where they assign authority to their subordinates and foster their growth and success by offering them valuable resources, guidance, and opportunities [22]. Servant leadership is thus characterized by altruism, empowerment, and love for subordinates [23]. Existing studies have shown that servant leadership, as a positive leadership style, can bring a range of positive outcomes to hospitals, such as improving nursing team performance [24], enhancing clinical nurses’ thriving at work [25], and reducing nurse burnout [26]. Although numerous studies have revealed the positive effects of servant leadership on hospitals, its possible negative effects have received little attention from scholars, and it has been shown that servant leadership, under certain conditions, induces employees to engage in unethical pro-organizational behavior, which brings harm to the organization in the long run [14]. Social information processing theory emphasizes that the internal and external environments of organizations are filled with a variety of information and that individuals’ perceptions and interpretations of this received information directly affect their attitudes and behaviors [15]. Leaders, as agents of the organization, are the main source of information for individuals in the organization, especially in organizations with high power distance, such as hospitals [27], where every move of the leader is the focus of attention of subordinates. People often view servant leadership as a leadership style that prioritizes personal integrity and prioritizes the interests of others. Furthermore, Servant leadership empowers subordinates by encouraging and facilitating their ability to take responsibility, overcome obstacles, and decide when and how to complete their work tasks [28], these positive messages allow medical staff to perceive that their leaders trust, recognize, and value them, at this point, this people-centered attitude helps to build a strong relationship between leaders and their subordinates [29], and promotes the identification of medical staff with the organization’s identity [30]. High organizational identification situations can induce unethical pro-organizational behavior in individuals [18]. The analysis above suggests the following hypothesis: Hypothesis 1: Servant leadership significantly and positively influences the unethical pro-organizational behavior of medical staff. The Mediating Role of Work Meaning Work meaning implies that an individual has a relationship of commitment, loyalty, and dedication to an organization or workplace [31]. Since work plays a crucial and fundamental role in people’s lives, scholars from various disciplines have focused their attention on work meaning [32], but work meaning is a complex social and psychological phenomenon, making it challenging for scholars to reach a consensus on its definition. However, scholars generally believe that the work meaning encompasses both subjective elements from the psychological perspective and socially oriented elements from the sociological perspective, which include the three dimensions of importance, beyond the self-interested purpose of work, and self-fulfillment, the concept of importance refers to an individual’s belief in the value of their work [33], the concept beyond the self-interested purpose of work signifies that the purpose of work is not solely self-directed but also has a positive impact on others and even the world [34], and self-fulfillment signifies the ability to work and realize one’s potential and purpose [35].Importance is an overall judgment of the value of the work, while self-fulfillment and the self-interested purpose of work are two key underpinnings when making an overall judgment [36]. In an organizational context, leaders are important influencers of subordinates’ attitudes and behaviors. Research demonstrates that leadership behavior shapes the work meaning of subordinates [37,38]. Servant leadership focuses on their employees’ needs and growth and demonstrates a willingness to delegate, exemplifying an altruistic leadership style grounded in moral principles [21]. According to the social information processing theory, servant leadership is an important cue and source of information for subordinates to understand the organizational environment and can significantly influence their evaluations and self-perceptions of the organization. Servant leaders are honest, upright, fair, and trustworthy in their dealings [39], and can create an ethical climate in the organization. In a highly ethical environment, employees will take pride in pursuing their goals in the right way, which will contribute to their work meaning [38]. Additionally, servant leadership prioritizes serving subordinates and assisting them in their personal growth and development, as this is one of the primary sources of work meaning [40]. Work meaning is important because it is a basic human need. It serves as a key psychological factor for individuals to increase job satisfaction, high-quality job performance, and lower turnover. Additionally, work meaning may impact more work-related outcomes through job engagement, commitment, and job satisfaction [41]. Research has demonstrated that work meaning can significantly increase an individual’s organizational commitment [42], patient care satisfaction [43], etc. Individuals with high levels of commitment, tend to behave in a way that is more aligned with the expectations, needs, and interests of the organization, and they are usually strongly motivated to engage in pro-organizational behavior to benefit the organization, even if they know that such behavior is unethical for those outside the organization [44]. Therefore, individuals with a strong work meaning are motivated to engage in unethical pro-organizational behavior. The analysis above suggests the following hypotheses: Hypothesis 2: Work meaning mediates the relationship between servant leadership and unethical pro-organizational behavior among medical staff. The Moderating Role of Power Distance As an important cultural value, individual power distance represents the extent to which individuals accept the uneven distribution of power in organizations [45], reflecting a set of beliefs about their role in organizations and society [46]. Individuals with high power distance tend to acknowledge the existence of distinct hierarchical and status differences between their superiors and subordinates, adhering to their role norms and demonstrating a greater willingness to accept managerial demands and obey their leaders’ orders [47]. However, individuals with low power distance hold the belief that leaders and subordinates possess equal rights, regardless of the existence of distinct work roles. They rarely experience constraints from hierarchical relationships, and they often choose to share their ideas and discuss their work with their supervisors [48]. Thus, an individual’s power distance may shape the nature of the subordinate-leader relationship [49], thereby influencing subordinates’ perceptions of and reactions to the leader. In summary, power distance is a cultural value that is particularly relevant to leadership [50]. It can influence the fit between leaders and subordinates, predict the effectiveness of leadership efficacy, and reflect the extent to which subordinates expect and accept that “they lead in a top-down direction” [51]. According to the social information processing theory, the organizational environment provides not only cues that individuals use to construct and interpret events but also information that influences their attitudes and perceptions. Medical staff interpret information from servant leadership, and the cultural values they hold, that is, power distance, influence this interpretation, thus affecting the strength of the influence of servant leadership on medical staff’s work meaning. Specifically, medical staff with high power distance unconditionally respect and obey their leaders [52]. This relationship intensifies the impact of servant leadership on the work meaning among medical staff. On the contrary, medical staff with low power distance do not pay much attention to differences in power level and status; they dare to challenge authority, pursue equal relationships, and do not easily follow the leader’s ideas. Therefore, power distance does not impact the relationship between servant leadership and the medical staff’s work meaning. We derive the following hypotheses from the above analysis: Hypothesis 3: Power distance plays a moderating role in the relationship between servant leadership and work meaning: the higher the power distance, the stronger the role of servant leadership in positively influencing the work meaning. Based on the above hypotheses, we further propose a moderated mediated effects model (see Figure 1); that is, varying degrees of power distance moderated the indirect effect of servant leadership influencing unethical pro-organizational behavior through the work meaning. In other words, servant leadership has a greater role in influencing unethical pro-organizational behavior through work meaning in high power distance contexts than in low power distance contexts. Hypothesis 4: Power distance moderates the indirect effect of servant leadership on the unethical pro-organizational behavior of medical staff through work meaning. The higher the power distance, the stronger this indirect effect. Combining the above hypotheses, this paper draws a theoretical model as shown in Figure 1. Methods Research Sample The sample of this study came from the medical staff of more than ten public hospitals in Guangdong and Guangxi Province of China. A total of 464 questionnaires were collected, and 420 valid questionnaires were obtained after eliminating the questionnaires that did not meet the requirements. Among the valid data of the survey, there were 240 males, accounting for 57.1%, and 180 females, accounting for 42.9%. In terms of the age of the sample, there are 27 people aged 25 and below, accounting for 6.4%; 93 people aged 26-30, accounting for 22.1%; 49people aged 31-35, accounting for 11.7%; 86 people aged 36-40, accounting for 20.5%; 78 people aged 41-45, accounting for 18.6%; and 87 people aged 46 and above, accounting for 20.7%. About the educational level of the sample, there were 7 persons with high school education or below, accounting for 1.7%;41 persons with specialized education, accounting for 9.8%; 221 persons with bachelor’s degree, accounting for 52.6%; and 151 persons with master’s degree or above, accounting for 36%. Regarding the professional titles, there were 31 people, or 5.8%, who were undecided; 247 people, or 58.8%, who were junior;99 people, or 23.6%, who were intermediate; and 43 people, or 10.24%, who were senior. In terms of the sample’s position, there were 195 physicians (46.4%), 67 nurses (16%), 121 medical technicians (28.8%), and 37 others (8.8%). Variable Measurement The scales used in this study are all mature scales that have been used many times in authoritative literature at home and abroad or scales adapted from authoritative scales in Chinese and undergo strict translation-back-translation procedures to ensure the validity of the questionnaire in the Chinese context. Servant Leadership This variable was measured using the Servant Leadership Scale developed by Liden et al.[53] which consists of 7 items and is scored on a 5-point Likert scale. A representative item is “My manager can tell if something work-related is going wrong.” The Cronbach’s alpha coefficient for this scale in this study was 0.91. Unethical Pro-organizational Behavior This variable was measured using a questionnaire developed by Umphress et al.[54] with 6 items scored on a 5-point Likert scale. Representative items include “If it would help my organization, I would misrepresent the truth to make my organization look good.” The Cronbach’s alpha coefficient for this scale in this study was 0.90. Work Meaning This variable was measured using the Work Meaning Scale developed by Steger et al.[55] which consists of 10 entries and is scored on a 5-point Likert scale. Representative items include “My work helps me better understand myself.” The Cronbach’s alpha coefficient for this scale in this study was 0.95. Power Distance This variable was measured using a questionnaire developed by Dorfman and Howell.[56] on a 5-point Likert scale. Representative items include “I don't think supervisors need to consult employees when making most decisions” and “I don’t think subordinates should object to supervisors’ decisions”. The Cronbach’s alpha coefficient for this scale was 0.90 in this study. Control variables According to existing studies, individual characteristic variables such as gender, age, education, title, and position will have an impact on the attitudes and behaviors of medical staff, therefore, to safeguard the scientific validity of the conclusions of this study, the above individual characteristic variables are treated as control variables. Data analysis Common Method Variance (CMV) The variables in this study were evaluated by medical staff, and although we emphasized the anonymity of the subjects and the academic research purpose of the questionnaire in the cover letter of the questionnaire, it is difficult to completely avoid the problem of common method variance. The methodological analysis using the Harman one-way test showed that the first variable explained only 30.8% of the variance when unrotated, which is far below the critical criterion of 50%. In addition, as can be seen in Table 1, the four-factor model fit best (χ2=414.67,df=371, χ2/df=1.12, RMSEA=0.017, CFI=1.00, NFI=0.98) was significantly better than the other models, which indicates that the discriminant validity between the variables of the present study is better, which suggests that the sample data do not suffer from a serious problem of common method variance. Table 1 Validation factor analysis Model χ 2 df RMSEA CFI NFI Four-factor model：SL; WM; PD; UPB 414.67 371 0.017 1.00 0.98 Three-factor model：SL+ WM; PD; UPB 4614.18 374 0.16 0.90 0.89 Three-factor model：SL+ PD; WM; UPB 4559.80 374 0.16 0.90 0.89 Three-factor model：SL; WM; PD + UPB 4563.18 374 0.16 0.90 0.88 Two-factor model：SL+ WM; PD + UPB 7045.54 376 0.21 0.86 0.84 Single-factor model：SL+ WM + PD + UPB 7444.71 377 0.21 0.85 0.84 Note: N=420. SL stands for Servant Leadership, WM stands for Work Meaning, PD stands for Power Distance, UPB stands for Unethical pro-organizational behavior, and “+” stands for Merger. Descriptive statistics and correlation analysis As shown in Table 2, the mean values of servant leadership, work meaning, unethical pro-organizational behavior, and power distance were 3.294, 3.286, 3.226, and 3.255, respectively. Work meaning (r=0.410, p<0.01), unethical pro-organizational behavior (r=0.333, p<0.01), and power distance (r=0.413, p<0.01) were significantly positively correlated with servant leadership significantly and positively; unethical pro-organizational behavior(r=0.327, p<0.01), power distance (r=0.410, p<0.01) and work meaning significantly and positively; power distance (r=0.296, p<0.01) and unethical pro-organizational behavior significantly and positively. Table 2 Descriptive statistics and correlation analysis of variables Variables M SD 1 2 3 4 1. Servant leadership 3.294 0.92 1 2. Work meaning 3.286 0.99 0.410** 1 3. Unethical pro-organizational behavior 3.226 0.96 0.333** 0.327** 1 4. Power distance 3.255 0.94 0.413** 0.410** 0.296** 1 Note：** p＜0.01；N=420. Hypothesis testing Mediating Role of Work Meaning The results of the test of the mediating role of work meaning are shown in Table 3, from which it can be seen that servant leadership has a significant effect on the unethical pro-organizational behavior of the medical staff (Model 2, β = 0.332, p < 0.01), therefore, Hypothesis 1 in this study is verified. In addition, servant leadership had a significant effect on the medical staff’s work meaning (Model 7, β = 0.407, p < 0.01). Model 4 added the mediating variable of work meaning to Model 2, and the coefficient of work meaning was significant (β = 0.236, p < 0.01), but the effect of servant leadership on unethical pro-organizational behavior was reduced, but there was still a significant positive effect (β = 0.236, p < 0.01). Thus, there is a partial mediating role of work meaning between servant leadership and the unethical pro-organizational behavior of medical staff. Thus, hypothesis 2 was tentatively supported by the data. To further test the mediating role of work meaning, this study used the bootstrapping method to calculate the effect values and confidence intervals. The indirect effect value of servant leadership affecting medical staff’s unethical pro-organizational behaviors was 0.098, and the confidence intervals at the 95% level were [0.055,0.148], which means that work meaning mediated the relationship between servant leadership and medical staff’s unethical pro-organizational behavior. Meanwhile, servant leadership directly and significantly influenced the medical staff’s unethical pro-organizational behavior (β = 0.248, confidence interval [0.147, 0.348]), therefore, Hypothesis 2 was verified. Table 3 Multiple regression analysis results Variables Unethical pro-organizational behavior Work meaning M 1 M 2 M 3 M 4 M 5 M 6 M 7 Control variables Gender -0.159 -0.070 -0.073 -0.067 -0.015 -0.027 -0.014 Age 0.007 0.004 0.000 -0.002 0.040 0.035 0.027 Education 0.037 -0.003 0.020 0.001 -0.017 -0.017 -0.018 Title -0.013 -0.036 -0.027 -0.040 0.009 0.015 0.017 Position 0.004 0.012 0.059 0.048 -0.145 -0.119** -0.153** Independent Variables Servant leadership 0.332** 0.236** 0.289** 0.26** 0.407** Mediating variable Work meaning 0.334** 0.236** Moderating Variables Power distance 0.285** 0.274** Interaction term Servant leadership * Power distance 0.216** R 2 0.008 0.116 0.116 0.161 0.259 0.304 0.192 △ R 2 -0.004 0.103** 0.103** 0.147** 0.246** 0.29** 0.18** F 0.629 9.056** 9.004** 11.325** 20 .57** 22.404** 16.341** Note：** p＜0.01；N=420. Moderating Role of Power Distance This study used regression analysis to test the moderating role of power distance between servant leadership and medical staff’s work meaning. Model 5 in Table 3 shows that there is a significant positive effect of servant leadership on medical staff’s work meaning (b = 0.289, p < 0.01), and Model 6 adds the interaction term between servant leadership and power distance based on Model 5, and the interaction coefficient is significant (b = 0.216, p < 0.01). It indicates that power distance plays a moderating role in the relationship between servant leadership and medical staff’s work meaning. Therefore, Hypothesis 3 was validated. To further analyze whether there was a mediated moderating effect, we used the SPSS Process to calculate the conditional indirect effect and INDEX for different value scenarios of power distance. From the results of the analysis of the conditional indirect effect on the left side of Table 4, it can be seen that when the medical staff power distance was at a low value, one standard deviation below the mean, the indirect effect was 0.009, and the confidence interval at the 95% level was [-0.022,0.043], and since the confidence interval contains 0, this indicates that the indirect effect of servant leadership influencing medical staff’s unethical pro-organizational behavior via a work meaning is not significant; when medical staff’s power distance is at a high value, one standard deviation above the mean, the indirect effect is 0.115, and the confidence interval at the 95% level is [0.065,0.174], and since the confidence interval does not contain 0, this suggests that the indirect effect of servant leadership via work meaning influencing medical staff’s unethical pro-organizational behavior is significant. Consequently, when work meaning serves as a mediating variable, the stronger effect of servant leadership on medical staff’s unethical pro-organizational behavior as power distance increases. The right half of Table 4 reports the mediated moderating effect determination indicator value INDEX, power distance has a moderating effect on the indirect relationship servant leadership affecting medical staff unethical pro-organizational behavior determination indicator value 0.056 with a standard error of 0.016 and a confidence interval of [0.029,0.090], and since the above confidence intervals do not contain zero, power distance moderates the servant leadership indirect relationship on medical staff’s unethical pro-organizational behavior through work meaning. The higher the power distance, the stronger this indirect effect. Hypothesis 4 was tested. Table 4 Results of Bootstrapping analysis with mediated moderated effects variable conditional indirect effect Moderated mediation effect moderator effect SE 95%LLCI 95%ULCI INDEX SE 95% LLCI 95%ULCI Work meaning low value 0.009 0.016 -0.022 0.043 0.056 0.016 0.029 0.09 high value 0.115 0.027 0.065 0.174 To visualize the mediating role of power distance, this study plotted the mediating role of power distance between servant leadership and medical staff’s work meaning according to the plotting method recommended by Aiken and West [57]. As can be seen in Figure 2, when power distance is at a high level (mean + 1 standard deviation), it enhances the positive effect of servant leadership on medical staff’s work meaning, while when power distance is at a low level (mean - 1 standard deviation), the mediating effect is insignificant in the process of servant leadership’s influence on medical staff’s work meaning. Hypotheses 3 and 4 were further supported. Discussion Theoretical Contributions First, servant leadership is one of the most important triggers for unethical pro-organizational behavior among medical staff. The manager’s greater demonstration of servant leadership correlates with an increased propensity among medical staff to engage in pro-organizational behaviors, such as voice behavior [24]. The results of the study indicated that servant leadership in hospitals had a beneficial impact on the unethical pro-organizational behavior of medical staff. This indicates that, under specific circumstances, positive leadership may adversely affect organizations, according to the results of analog studies [58]. This outcome provides additional evidence about the correlation between positive leadership and unethical pro-organizational behavior. Second, the work meaning mediated the connection between servant leadership and unethical pro-organizational behavior among medical staff. In recent years, unethical pro-organizational behavior among medical staff has attracted considerable scholarly interest, but a dearth of empirical studies.(59) This study examined the reasons underlying unethical pro-organizational behavior among medical staff through a lens of positive leadership styles informed by cultural values. The research indicated that servant leadership improved work meaning among medical staff, thereby promoting their unethical pro-organizational behavior. This finding reveals the ‘black box’ of servant leadership influence on medical staff unethical pro-organizational behavior, which may provide insights into the mechanisms that shape unethical pro-organizational behavior and enrich the research literature on work meaning in Management Psychology. Last, this study elucidates the moderating effect of power distance on the indirect relationship between the impact of servant leadership and the unethical pro-organizational behavior of medical staff, shaped by their work meaning. Understanding the boundary conditions of the creation mechanism for unethical pro-organizational behavior among medical staff is essential. The research revealed that individual power distance affected the magnitude of the indirect impact of servant leadership, via work meaning, on the unethical pro-organizational behavior of medical staff. Relative to low power distance, high power distance enhanced the positive influence of servant leadership on medical staff’s unethical pro-organizational behavior. This finding not only enriches the research on the moderating variables of unethical pro-organizational behavior but also provides avenues of intervention for preventing and controlling the occurrence of unethical pro-organizational behavior among medical staff. In addition, power distance, asan important cultural value, has seldom been introduced into the study of unethical pro-organizational behavior theory in the past. Therefore, this study goes some way to remedying the lack of emphasis on contextual factors such as cultural values in the study of unethical pro-organizational behavior. Management Implications Based on empirical findings and the fact that unethical pro-organizational behavior is potentially risky for hospitals, the implications of this study for hospital management are as follows: (1)Be alert to the negative impacts of servant leadership. Existing literature focuses on the positive impacts of servant leadership, and many organizations select and develop servant leadership; however, they may have overlooked the dark side of servant leadership. Therefore, hospitals should consider the positive effects of servant leadership, along with the development of proper ethical values and work codes of conduct for medical staff. (2)Strengthening the servant leadership style. Hospitals should carry out style construction in their cadres, strengthen moral cultivation, establish a sense of rules and regulations, promote the Core Values of Chinese Socialism, resolutely oppose all unethical behaviors in hospitals, and prevent unethical behaviors from occurring. (3)Building high-quality superior-subordinate relationships. There are differences in the perceptions and reactions of medical staff to different power distances from their leaders. For medical staff with high power distance, leaders need to be properly guided when they play their role of carrying out orders without compromise and guarding against the occurrence of unethical behavior because of their loyalty to the hospital. Therefore, leaders need to strengthen communication and interaction with their subordinates, build high-quality superior-subordinate relationships, and reduce power distance to prevent unethical behavior. Limitations and Future Research This study has some limitations. First, it relies on social information processing theory to investigate how servant leadership influences the unethical pro-organizational behavior of medical staff, without taking into account other theoretical perspectives. Future research should use social identity theory to explore the relationship between servant leadership and medical staff’s unethical pro-organizational behavior. Second, the survey data were concentrated in public hospitals in Guangdong, Guangxi, Yunnan Province, and Jiangxi Province of China, which may have reduced the external effect of the data. Future research can further improve the sampling region by sampling medical staff in public hospitals from the eastern, central, and western regions according to the economic development of China to improve the external effect of the study. Finally, in conducting the research design of this study, only the cultural value of power distance was considered as a boundary condition for the effect of servant leadership on medical staff’s unethical pro-organizational behavior, while organizational-level moderating variables such as organizational ethical climate were not considered; future research could consider introducing organizational-level moderating variables into the research model to more fully understand the formation process of medical staff’s unethical pro-organizational behavior. Declarations Authors’ contributions All authors made significant contributions to the conception of the article, the design and execution of the study, and the acquisition, analysis, and interpretation of the data. During the creation of the article, the authors all contributed to the drafting process, revising and reviewing the content repeatedly. In the end, the version of the article for publication was unanimously endorsed and approved for submission to the journal. It was also agreed to assume responsibility for the content of the text. Fundings 2024 Guangdong Pharmaceutical University “discipline cultivation, innovation and quality” project team project (2024ZR01) Guangdong Province Philosophy and Social Science Planning Project (GD21CJY02) Data Availability The data supporting the findings in this study are available from the corresponding author. Ethics approval and consent to participate This study was approved by the Ethics Committee of the Business School of Pharmaceutical, Guangdong Pharmaceutical University（Approval number 2022009）. The research process was conducted following the Declaration of Helsinki. The Committee agreed to conduct a questionnaire survey of the medical staff of public hospitals in Guangdong, Guangxi China, etc. The questionnaire was administered with the consent of the respondents to begin the survey, and all respondents participated in this study voluntarily. Consent for publication Not applicable. Competing interests The authors report no competing interests in this work. Acknowledgements Not applicable. References Qiu Y. Cultivating Medical Ethics and Practicing Compassionate Surgery: A Study on the Current Situation and Countermeasures for the Development of Medical Ethics in Public Hospitals. J Tradit Chin Med Manag. 2023;31(20):46–9. Tan Y, Liao J, Wang S. 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The Benefits of Benevolence: Basic Psychological Needs, Beneficence, and the Enhancement of Well-Being. J Pers. 2016;84(6):750–64. Lieff SJ. Perspective: The Missing Link in Academic Career Planning and Development: Pursuit of Meaningful and Aligned Work. Acad Med. 2009 Oct;84(10):1383. Martela F, Pessi AB. Significant Work Is About Self-Realization and Broader Purpose: Defining the Key Dimensions of Meaningful Work. Front Psychol [Internet]. 2018 Mar 26 [cited 2024 Oct 31];9. Available from: https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2018.00363/full Pradhan S, Pradhan R. Transformational Leadership and Job Outcomes: The Mediating Role of Meaningful Work. Glob Bus Rev. 2016 Apr 22;17. Wang Z, Xu H. When and for Whom Ethical Leadership is More Effective in Eliciting Work Meaningfulness and Positive Attitudes: The Moderating Roles of Core Self-Evaluation and Perceived Organizational Support. J Bus Ethics. 2019 Jun 1;156(4):919–40. Long L, Chen X. The Impact of Servant Leadership on Employee Community Citizenship Behavior:The Role of Psychological Empowerment. J South China Norm Univ Soc Sci Ed. 2020;(6):117-126+191. Lips-Wiersma M, Morris L. Discriminating Between ‘Meaningful Work’ and the ‘Management of Meaning’. J Bus Ethics. 2009 Sep 1;88(3):491–511. Allan BA, Batz-Barbarich C, Sterling HM, Tay L. Outcomes of Meaningful Work: A Meta-Analysis. J Manag Stud. 2019;56(3):500–28. Jung HS, Yoon HH. What does work meaning to hospitality employees? The effects of meaningful work on employees’ organizational commitment: The mediating role of job engagement. Int J Hosp Manag. 2016;53:59–68. Leiter MP, Harvie P, Frizzell C. The correspondence of patient satisfaction and nurse burnout. Soc Sci Med. 1998 Nov 1;47(10):1611–7. Luan Y, Zhao K, Wang Z, Hu F. Exploring the Antecedents of Unethical Pro-organizational Behavior (UPB): A Meta-Analysis. J Bus Ethics. 2023 Sep 1;187(1):119–36. Hofstede G. Dimensionalizing Cultures: The Hofstede Model in Context. Online Read Psychol Cult [Internet]. 2011 Dec 1 [cited 2024 Oct 31];2(1). Jehanzeb K. How perception of training impacts organizational citizenship behavior: power distance as moderator. Pers Rev. 2022 Jan 1;51(3):922–44. Wang S, Wu J, He C, Gu J. The impact of authoritarian leadership on employee creativity: the joint moderating roles of benevolent leadership and power distance. J Manag Psychol. 2022 Feb 11;37(6):527–44. Hou J, Qian L, Zhang C. Understanding the Effects of Colleague Participation and Public Cause Proximity on Employee Volunteering Intentions: The Moderating Role of Power Distance. Front Psychol. 2020;11:552867. Lee C, Pillutla M, Law KS. Power-distance, gender, and organizational justice. J Manag. 2000;26(4):685–704. Kirkman BL, Chen G, Farh JL, Chen ZX, Lowe KB. Individual Power Distance Orientation and Follower Reactions to Transformational Leaders: A Cross-Level, Cross-Cultural Examination. Acad Manage J. 2009 Aug;52(4):744–64. Ehrnrooth M, Koveshnikov A, Balabanova E, Wechtler H. Western and non-western leadership styles and employee wellbeing: a case of a high-power distance context. Front Psychol [Internet]. 2024 Jan 19 [cited 2024 Oct 31];14. Zou W, Zeng Y, Peng Q, Xin Y, Chen J, Houghton JD. The influence of spiritual leadership on the subjective well-being of Chinese registered nurses. J Nurs Manag. 2020 Sep;28(6):1432–42. Liden RC, Wayne SJ, Liao C, Meuser JD. Servant Leadership and Serving Culture: Influence on Individual and Unit Performance. Acad Manage J. 2014 Oct;57(5):1434–52. Umphress EE, Bingham JB, Mitchell MS. Unethical behavior in the name of the company: The moderating effect of organizational identification and positive reciprocity beliefs on unethical pro-organizational behavior. J Appl Psychol. 2010;95(4):769–80. Steger MF, Dik BJ, Duffy RD. Measuring meaningful work: The Work and Meaning Inventory (WAMI). J Career Assess. 2012;20(3):322–37. Dorfman P, Howell J. Dimension of national culture and effective leadership patterns: Hofstede revisited. In: Advances in International Comparative Management. 1988. p. 127–49. Aiken LS, West SG. Multiple regression: Testing and interpreting interactions. Thousand Oaks, CA, US: Sage Publications, Inc; 1991. xi, 212 p. (Multiple regression: Testing and interpreting interactions). Cao Z, Wang T, Song Y. Do Self-Sacrificing Leaders Promote Employees’ Unethical Pro-Organizational Behavior? --The mediating role of organizational identification and its effect boundaries. Hum Resour Dev China. 2019;36(6):21–32. Luo Y, Jiang Y, Li G, Liu R, Zhang H. A study of pro-organizational non-ethical behaviors of healthcare workers from the perspective of performance appraisal goal orientation. J Xinxiang Med Univ. 2018;35(11):1009–12. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6429672","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":453209796,"identity":"2344dfe0-56b8-4580-93c3-345063c14214","order_by":0,"name":"Jianji Zeng","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABB0lEQVRIiWNgGAWjYLACCQMGBsZm5gMHEipsePj5G4jWwpb44MOZNBnJGQeItovH2HBmy2Ebg4YE/Ork23sPv7AosMtjbmcwk+ZtOM9jwHCA8cPHHNxaGHvOpVlIGCQXMzYzpEnz7rjNY87cwCw5cxtuLcwSOWYGEgbMiY3NDMekec/c5rFsOMDGzItHC5v8G5CWeqAWxjZp3rZzPAYHEvBr4ZHgMX4gYXAYqIWZ2XBm2wHCWiR4csyAgXwcqIWNERjIyTySMw424/WLfPsZ488Sf6oTN/af/wCMSjt7fv7mgx8+4tEC8o60BJA0bIALMDbgUgoDzB8/gKwjpGwUjIJRMApGLgAAvZ1Q+jT4uxYAAAAASUVORK5CYII=","orcid":"","institution":"Guangdong Pharmaceutical University","correspondingAuthor":true,"prefix":"","firstName":"Jianji","middleName":"","lastName":"Zeng","suffix":""},{"id":453209797,"identity":"b442241b-e062-440a-8867-2de87a903aef","order_by":1,"name":"Jing Cai","email":"","orcid":"","institution":"Guangdong Pharmaceutical University","correspondingAuthor":false,"prefix":"","firstName":"Jing","middleName":"","lastName":"Cai","suffix":""},{"id":453209798,"identity":"d965bb03-cbe3-45e6-916c-5b6ab0720f37","order_by":2,"name":"Liuxiang Li","email":"","orcid":"","institution":"Discipline Inspection Commission Office, Beiliu People’s Hospital, Yulin City, Guangxi Zhuang Autonomous Region, Beiliu","correspondingAuthor":false,"prefix":"","firstName":"Liuxiang","middleName":"","lastName":"Li","suffix":""},{"id":453209799,"identity":"a4d98c98-f657-45bf-85df-445a3c36acf3","order_by":3,"name":"Qing Yang","email":"","orcid":"","institution":"Guangdong Pharmaceutical University","correspondingAuthor":false,"prefix":"","firstName":"Qing","middleName":"","lastName":"Yang","suffix":""}],"badges":[],"createdAt":"2025-04-11 15:38:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6429672/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6429672/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12913-025-13502-1","type":"published","date":"2025-10-24T16:16:10+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":82290384,"identity":"279f9d7e-0a4b-489e-8f73-02e62319a828","added_by":"auto","created_at":"2025-05-08 17:28:08","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":32998,"visible":true,"origin":"","legend":"\u003cp\u003eTheoretical model of this study\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6429672/v1/7cbaef1f168ad1ece3991e9d.png"},{"id":82290385,"identity":"26c83383-f21d-44a3-9eb0-0b6e9d4850b9","added_by":"auto","created_at":"2025-05-08 17:28:08","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":59628,"visible":true,"origin":"","legend":"\u003cp\u003eModerating effect of power distance on the relationship between servant leadership and work meaning\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6429672/v1/747c88fc762503b8deaae8c0.png"},{"id":94490717,"identity":"89afc26c-ff16-49f7-bead-e00ce2c422cf","added_by":"auto","created_at":"2025-10-27 17:14:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":968127,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6429672/v1/e018cc30-365b-42f0-b326-90009c9531c1.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The effect of Servant Leadership on Medical Staff Unethical Pro-organizational Behavior: The role of Work Meaning and Power Distance ","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003ePublic attention has always focused on health and wellness organizations with hospitals at their core, the exposure of scandals in Chinese hospitals, such as that of Dr Liu Xiangfeng at the Second Xiangya Hospital of Central South University, has brought unethical behavior in hospitals to the attention of a wide range of public opinion. A survey of medical staff showed that 30% admitted that there was a problem with large prescriptions in the medical industry; 32.5% believed that there was a situation in the medical sector where patients were induced to undergo unnecessary tests, and even more than one-third admitted that there was a situation of drug abuse and so on [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It is generally believed that unethical behaviors are mainly actions committed by individuals to seek private gain or revenge against organizations that are against society\u0026rsquo;s moral code [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. However, some studies have also shown that individuals commit unethical behaviors with complex motives\u0026mdash;not necessarily for personal self-interest but possibly for organizational benefit [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The China National Healthcare Security Administration investigated 111 typical health insurance fraud cases between September 2018 and March 2022 [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], with medical staff orchestrating some instances to obtain health insurance funds and boost hospital revenues fraudulently. There are serious unethical behaviors in certain hospital organizations.\u003c/p\u003e \u003cp\u003eIn recent years, unethical behaviors within organizations have garnered heightened academic interest and emerged as a prominent subject of inquiry in Management Psychology. Scholars refer to persons who participate in actions that benefit the organization or other members (e.g., leaders), yet violate portions of essential core socialist values, morality, and the law as unethical pro-organizational behavior [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In essence, unethical pro-organizational behavior, as a specific type of unethical, combines the conflicting characteristics of both \u0026lsquo;pro-organizational\u0026rsquo; and \u0026lsquo;unethical\u0026rsquo; practices. Organizations frequently overlook, comply with, or even promote it under the pretense of being \u0026lsquo;pro-organizational\u0026rsquo; despite its ethical dilemmas and adverse impacts on the interests of customers and other external stakeholders [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Ultimately, this activity may seriously influence the reputation and growth of the organization [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In China, traditional Confucian culture promotes the values of individual subordination to the collective, subordinates following the leader and valuing collective interests, and these may lead to pro-organizational non-ethical behaviors are not uncommon in Chinese social organizations [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], especially in public hospitals where the distance of power is high, as seems to be corroborated by the frequent cases of fraudulent insurance policies that have occurred in Chinese hospitals in recent years. Public hospitals are the primary component of China\u0026rsquo;s healthcare system, serving as protectors of public health and a crucial assurance for advancing high-quality health services. Consequently, the public hospital healthcare workforce\u0026rsquo;s growth is paramount. Therefore, examining unethical pro-organizational behavior among medical staff in public hospitals carries major theoretical and practical significance.\u003c/p\u003e \u003cp\u003eCurrent literature indicates that leadership style is crucial to an individual\u0026rsquo;s unethical pro-organizational behavior, including paternalistic leadership [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], transformational leadership [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], and empowering leadership [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Surprisingly, there has rarely been an explicit examination of the impact of Servant leadership on subordinates\u0026rsquo; unethical pro-organizational behavior, particularly within medical institutions. This leadership style, characterized by its supporting nature, prioritizes the interests of subordinates and emphasizes their growth and career development, making it highly esteemed by social organizations, especially hospitals. Current research on servant-leadership effectiveness primarily emphasizes its beneficial influence on employee behavior, including innovative behavior [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] and work prosperity [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]; however, this ostensibly ideal leadership style may also induce negative consequences in specific contexts, such as promoting unethical pro-organizational behavior among subordinates [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Examining the adverse repercussions of servant leadership is crucial as it can yield essential insights for interventions aimed at mitigating or eradicating these negative consequences while enhancing the understanding of the essence of servant leadership. Consequently, investigating the mechanisms that influence unethical pro-organizational behavior among medical staff from a servant leadership perspective holds considerable academic significance.\u003c/p\u003e \u003cp\u003eSocial information processing theory offers a theoretical framework for comprehending the unethical pro-organizational behavior of medical staff. Social information processing theory posits that the social information available to an individual offers cues that assist in interpreting the organizational environment, and varying interpretations of this environment by an individual affect their attitudes and behaviors [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. As a result, the medical staff\u0026rsquo;s work meaning is enhanced through a deep processing process of learning, attributing, coding, and evaluating the words and actions of servant leadership. Research indicates that an individual\u0026rsquo;s work meaning can profoundly affect their organizational identity [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], which is a crucial predictor of unethical pro-organizational behavior [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Therefore, by synthesizing social information processing theory and the literature on unethical pro-organizational behavior, we propose that work meaning mediates the relationship between servant leadership and influencing medical staff\u0026rsquo;s unethical pro-organizational behavior.\u003c/p\u003e \u003cp\u003eFurthermore, situational factors and personal characteristics impact individuals when processing social information, as postulated by the social information processing theory [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Research has demonstrated that individual characteristics serve as crucial boundary conditions in the shaping of unethical pro-organizational behavior [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Power distance is both an individual characteristic and an important cultural value that reflects the individual\u0026rsquo;s acceptance of job hierarchies and power differentials. It significantly influences the process and outcome of interactions between leaders and subordinates [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Consequently, the present study sought to ascertain the role of power distance as a moderator, thereby delineating the boundaries of the relationship between servant leadership and unethical pro-organizational behavior that benefits the organization among medical staff. In particular, the indirect effect of servant leadership on the unethical pro-organizational behavior of medical staff was found to be most pronounced at high power distance relative to low power distance. Consequently, by identifying the boundary conditions under which servant leadership influences the unethical pro-organizational behavior of medical staff, we can further comprehend the formation mechanism of unethical pro-organizational behavior based on the social information processing theory.\u003c/p\u003e \u003cp\u003eIn conclusion, this study examines the impact of servant leadership on the unethical pro-organizational behavior of medical staff, while also examining the mediating role of work meaning and the moderating role of power distance, all within the framework of social information processing theory. This study conducts an in-depth exploration of the internal psychological mechanism that forms the unethical pro-organizational behavior of medical staff. The objective is to clarify the triggering mechanism and provide useful ideas for relevant governmental departments and hospital organizations to intervene in this unethical pro-organizational behavior.\u003c/p\u003e"},{"header":"Research hypotheses","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eServant Leadership and Unethical Pro-organizational Behavior of Medical Staff\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eServant leadership advocates that leaders act as servants and put the interests of their subordinates first [21]. Servant leadership assists organizations in fostering a laid-back work atmosphere that fosters a sense of dedication to the organization, where they assign authority to their subordinates and foster their growth and success by offering them valuable resources, guidance, and opportunities [22]. Servant leadership is thus characterized by altruism, empowerment, and love for subordinates [23]. Existing studies have shown that servant leadership, as a positive leadership style, can bring a range of positive outcomes to hospitals, such as improving nursing team performance [24], \u0026nbsp;enhancing clinical nurses\u0026rsquo; thriving at work [25], and reducing nurse burnout [26]. Although numerous studies have revealed the positive effects of servant leadership on hospitals, its possible negative effects have received little attention from scholars, and it has been shown that servant leadership, under certain conditions, induces employees to engage in unethical pro-organizational behavior, which brings harm to the organization in the long run [14].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSocial information processing theory emphasizes that the internal and external environments of organizations are filled with a variety of information and that individuals\u0026rsquo; perceptions and interpretations of this received information directly affect their attitudes and behaviors [15]. Leaders, as agents of the organization, are the main source of information for individuals in the organization, especially in organizations with high power distance, such as hospitals [27], where every move of the leader is the focus of attention of subordinates. People often view servant leadership as a leadership style that prioritizes personal integrity and prioritizes the interests of others. Furthermore, Servant leadership empowers subordinates by encouraging and facilitating their ability to take responsibility, overcome obstacles, and decide when and how to complete their work tasks [28], \u0026nbsp;these positive messages allow medical staff to perceive that their leaders trust, recognize, and value them, at this point, this people-centered attitude helps to build a strong relationship between leaders and their subordinates [29], and promotes the identification of medical staff with the organization\u0026rsquo;s identity [30]. High organizational identification situations can induce unethical pro-organizational behavior in individuals [18]. The analysis above suggests the following hypothesis:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHypothesis 1: Servant leadership significantly and positively influences the unethical pro-organizational behavior of medical staff.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eThe Mediating Role of Work Meaning\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWork meaning implies that an individual has a relationship of commitment, loyalty, and dedication to an organization or workplace [31]. Since work plays a crucial and fundamental role in people\u0026rsquo;s lives, scholars from various disciplines have focused their attention on work meaning [32], but work meaning is a complex social and psychological phenomenon, making it challenging for scholars to reach a consensus on its definition. However, scholars generally believe that the work meaning encompasses both subjective elements from the psychological perspective and socially oriented elements from the sociological perspective, which include the three dimensions of importance, beyond the self-interested purpose of work, and self-fulfillment, the concept of importance refers to an individual\u0026rsquo;s belief in the value of their work [33], the concept beyond the self-interested purpose of work signifies that the purpose of work is not solely self-directed but also has a positive impact on others and even the world [34], and self-fulfillment signifies the ability to work and realize one\u0026rsquo;s potential and purpose [35].Importance is an overall judgment of the value of the work, while self-fulfillment and the self-interested purpose of work are two key underpinnings when making an overall judgment [36].\u003c/p\u003e\n\u003cp\u003eIn an organizational context, leaders are important influencers of subordinates\u0026rsquo; attitudes and behaviors. Research demonstrates that leadership behavior shapes the work meaning of subordinates [37,38]. Servant leadership focuses on their employees\u0026rsquo; needs and growth and demonstrates a willingness to delegate, exemplifying an altruistic leadership style grounded in moral principles [21]. According to the social information processing theory, servant leadership is an important cue and source of information for subordinates to understand the organizational environment and can significantly influence their evaluations and self-perceptions of the organization. Servant leaders are honest, upright, fair, and trustworthy in their dealings [39], and can create an ethical climate in the organization. In a highly ethical environment, employees will take pride in pursuing their goals in the right way, which will contribute to their work meaning [38]. Additionally, servant leadership prioritizes serving subordinates and assisting them in their personal growth and development, as this is one of the primary sources of work meaning [40].\u003c/p\u003e\n\u003cp\u003eWork meaning is important because it is a basic human need. It serves as a key psychological factor for individuals to increase job satisfaction, high-quality job performance, and lower turnover. Additionally, work meaning may impact more work-related outcomes through job engagement, commitment, and job satisfaction [41]. Research has demonstrated that work meaning can significantly increase an individual\u0026rsquo;s organizational commitment [42], patient care satisfaction [43], etc. Individuals with high levels of commitment, tend to behave in a way that is more aligned with the expectations, needs, and interests of the organization, and they are usually strongly motivated to engage in pro-organizational behavior to benefit the organization, even if they know that such behavior is unethical for those outside the organization [44]. Therefore, individuals with a strong work meaning are motivated to engage in unethical pro-organizational behavior. The analysis above suggests the following hypotheses:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHypothesis 2: Work meaning mediates the relationship between servant leadership and unethical pro-organizational behavior among medical staff.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eThe Moderating Role of Power Distance\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs an important cultural value, individual power distance represents the extent to which individuals accept the uneven distribution of power in organizations [45], reflecting a set of beliefs about their role in organizations and society [46]. Individuals with high power distance tend to acknowledge the existence of distinct hierarchical and status differences between their superiors and subordinates, adhering to their role norms and demonstrating a greater willingness to accept managerial demands and obey their leaders\u0026rsquo; orders [47]. However, individuals with low power distance hold the belief that leaders and subordinates possess equal rights, regardless of the existence of distinct work roles. They rarely experience constraints from hierarchical relationships, and they often choose to share their ideas and discuss their work with their supervisors [48]. Thus, an individual\u0026rsquo;s power distance may shape the nature of the subordinate-leader relationship [49], thereby influencing subordinates\u0026rsquo; perceptions of and reactions to the leader.\u003c/p\u003e\n\u003cp\u003eIn summary, power distance is a cultural value that is particularly relevant to leadership [50]. It can influence the fit between leaders and subordinates, predict the effectiveness of leadership efficacy, and reflect the extent to which subordinates expect and accept that \u0026ldquo;they lead in a top-down direction\u0026rdquo; [51]. According to the social information processing theory, the organizational environment provides not only cues that individuals use to construct and interpret events but also information that influences their attitudes and perceptions. Medical staff interpret information from servant leadership, and the cultural values they hold, that is, power distance, influence this interpretation, thus affecting the strength of the influence of servant leadership on medical staff\u0026rsquo;s work meaning. Specifically, medical staff with high power distance unconditionally respect and obey their leaders [52]. This relationship intensifies the impact of servant leadership on the work meaning among medical staff. On the contrary, medical staff with low power distance do not pay much attention to differences in power level and status; they dare to challenge authority, pursue equal relationships, and do not easily follow the leader\u0026rsquo;s ideas. Therefore, power distance does not impact the relationship between servant leadership and the medical staff\u0026rsquo;s work meaning. We derive the following hypotheses from the above analysis:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHypothesis 3: Power distance plays a moderating role in the relationship between servant leadership and work meaning: the higher the power distance, the stronger the role of servant leadership in positively influencing the work meaning.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBased on the above hypotheses, we further propose a moderated mediated effects model (see Figure 1); that is, varying degrees of power distance moderated the indirect effect of servant leadership influencing unethical pro-organizational behavior through the work meaning.\u0026nbsp;In other words, servant leadership has a greater role in influencing unethical pro-organizational behavior through work meaning in high power distance contexts than in low power distance contexts.\u003c/p\u003e\n\u003cp\u003eHypothesis 4: Power distance moderates the indirect effect of servant leadership on the unethical pro-organizational behavior of medical staff through work meaning. The higher the power distance, the stronger this indirect effect.\u003c/p\u003e\n\u003cp\u003eCombining the above hypotheses, this paper draws a theoretical model as shown in Figure 1.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eResearch Sample\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sample of this study came from the medical staff of more than ten public hospitals in Guangdong and Guangxi Province of China. A total of 464 questionnaires were collected, and 420 valid questionnaires were obtained after eliminating the questionnaires that did not meet the requirements. Among the valid data of the survey, there were 240 males, accounting for 57.1%, and 180 females, accounting for 42.9%. In terms of the age of the sample, there are 27 people aged 25 and below, accounting for 6.4%; 93 people aged 26-30, accounting for 22.1%; 49people aged 31-35, accounting for 11.7%; 86 people aged 36-40, accounting for 20.5%; 78 people aged 41-45, accounting for 18.6%; and 87 people aged 46 and above, accounting for 20.7%. About the educational level of the sample, there were 7 persons with high school education or below, accounting for 1.7%;41 persons with specialized education, accounting for 9.8%; 221 persons with bachelor\u0026rsquo;s degree, accounting for 52.6%; and 151 persons with master\u0026rsquo;s degree or above, accounting for 36%. Regarding the professional titles, there were 31 people, or 5.8%, who were undecided; 247 people, or 58.8%, who were junior;99 people, or 23.6%, who were intermediate; and 43 people, or 10.24%, who were senior. In terms of the sample\u0026rsquo;s position, there were 195 physicians (46.4%), 67 nurses (16%), 121 medical technicians (28.8%), and 37 others (8.8%).\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eVariable Measurement\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe scales used in this study are all mature scales that have been used many times in authoritative literature at home and abroad or scales adapted from authoritative scales in Chinese and undergo strict translation-back-translation procedures to ensure the validity of the questionnaire in the Chinese context.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eServant Leadership\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis variable was measured using the Servant Leadership Scale developed by Liden et al.[53] which consists of 7 items and is scored on a 5-point Likert scale. A representative item is \u0026ldquo;My manager can tell if something work-related is going wrong.\u0026rdquo; The Cronbach\u0026rsquo;s alpha coefficient for this scale in this study was 0.91.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUnethical Pro-organizational Behavior\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis variable was measured using a questionnaire developed by Umphress et al.[54] with 6 items scored on a 5-point Likert scale. Representative items include \u0026ldquo;If it would help my organization, I would misrepresent the truth to make my organization look good.\u0026rdquo; The Cronbach\u0026rsquo;s alpha coefficient for this scale in this study was 0.90.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWork Meaning\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis variable was measured using the Work Meaning Scale developed by Steger et al.[55] which consists of 10 entries and is scored on a 5-point Likert scale. Representative items include \u0026ldquo;My work helps me better understand myself.\u0026rdquo; The Cronbach\u0026rsquo;s alpha coefficient for this scale in this study was 0.95.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePower Distance\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis variable was measured using a questionnaire developed by Dorfman and Howell.[56]\u0026nbsp;on a 5-point Likert scale. Representative items include \u0026ldquo;I don\u0026apos;t think supervisors need to consult employees when making most decisions\u0026rdquo; and \u0026ldquo;I don\u0026rsquo;t think subordinates should object to supervisors\u0026rsquo; decisions\u0026rdquo;. The Cronbach\u0026rsquo;s alpha coefficient for this scale was 0.90 in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eControl variables\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccording to existing studies, individual characteristic variables such as gender, age, education, title, and position will have an impact on the attitudes and behaviors of medical staff, therefore, to safeguard the scientific validity of the conclusions of this study, the above individual characteristic variables are treated as control variables.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCommon Method Variance (CMV)\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe variables in this study were evaluated by medical staff, and although we emphasized the anonymity of the subjects and the academic research purpose of the questionnaire in the cover letter of the questionnaire, it is difficult to completely avoid the problem of common method variance. The methodological analysis using the Harman one-way test showed that the first variable explained only 30.8% of the variance when unrotated, which is far below the critical criterion of 50%. In addition, as can be seen in Table 1, the four-factor model fit best (\u0026chi;2=414.67,df=371, \u0026chi;2/df=1.12, RMSEA=0.017, CFI=1.00, NFI=0.98) was significantly better than the other models, which indicates that the discriminant validity between the variables of the present study is better, which suggests that the sample data do not suffer from a serious problem of common method variance.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;1\u0026nbsp;Validation factor analysis\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"105%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eModel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cem\u003edf\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003eRMSEA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003eCFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003eNFI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eFour-factor model：SL; WM; PD; UPB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e414.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e371\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eThree-factor model：SL+ WM; PD; UPB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e4614.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e374\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eThree-factor model：SL+ PD; WM; UPB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e4559.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e374\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eThree-factor model：SL; WM; PD + UPB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e4563.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e374\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eTwo-factor model：SL+ WM; PD + UPB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e7045.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e376\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eSingle-factor model：SL+ WM + PD + UPB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e7444.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e377\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: N=420. SL stands for Servant Leadership, WM stands for Work Meaning, PD stands for Power Distance, UPB stands for Unethical pro-organizational behavior, and \u0026ldquo;+\u0026rdquo; stands for Merger.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eDescriptive statistics and correlation analysis\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs shown in\u0026nbsp;Table 2, the mean values of servant leadership, work meaning, unethical pro-organizational behavior, and power distance were 3.294, 3.286, 3.226, and 3.255, respectively. Work meaning (r=0.410, p\u0026lt;0.01), unethical pro-organizational behavior (r=0.333, p\u0026lt;0.01), and power distance (r=0.413, p\u0026lt;0.01) were significantly positively correlated with servant leadership significantly and positively; unethical pro-organizational behavior(r=0.327, p\u0026lt;0.01), power distance (r=0.410, p\u0026lt;0.01) and work meaning significantly and positively; power distance (r=0.296, p\u0026lt;0.01) and unethical pro-organizational behavior significantly and positively.\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;2\u0026nbsp;Descriptive statistics and correlation analysis of variables\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"left\" width=\"103%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cem\u003eM\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e1. Servant leadership\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e3.294\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e2. Work meaning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e3.286\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.410**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e3. Unethical pro-organizational behavior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e3.226\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.333**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.327**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e4. Power distance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e3.255\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.413**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.410**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.296**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote：** p＜0.01；N=420.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eHypothesis testing\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMediating Role of Work Meaning\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results of the test of the mediating role of work meaning are shown in\u0026nbsp;Table 3, from which it can be seen that servant leadership has a significant effect on the unethical pro-organizational behavior of the medical staff (Model 2, \u0026beta; = 0.332, p \u0026lt; 0.01), therefore, Hypothesis 1 in this study is verified. In addition, servant leadership had a significant effect on the medical staff\u0026rsquo;s work meaning (Model 7, \u0026beta; = 0.407, p \u0026lt; 0.01). Model 4 added the mediating variable of work meaning to Model 2, and the coefficient of work meaning was significant (\u0026beta; = 0.236, p \u0026lt; 0.01), but the effect of servant leadership on unethical pro-organizational behavior was reduced, but there was still a significant positive effect (\u0026beta; = 0.236, p \u0026lt; 0.01). Thus, there is a partial mediating role of work meaning between servant leadership and the unethical pro-organizational behavior of medical staff. Thus, hypothesis 2 was tentatively supported by the data.\u003c/p\u003e\n\u003cp\u003eTo further test the mediating role of work meaning, this study used the bootstrapping method to calculate the effect values and confidence intervals. The indirect effect value of servant leadership affecting medical staff\u0026rsquo;s unethical pro-organizational behaviors was 0.098, and the confidence intervals at the 95% level were [0.055,0.148], which means that work meaning mediated the relationship between servant leadership and medical staff\u0026rsquo;s unethical pro-organizational behavior. Meanwhile, servant leadership directly and significantly influenced the medical staff\u0026rsquo;s unethical pro-organizational behavior \u0026nbsp;(\u0026beta; = 0.248, confidence interval [0.147, 0.348]), therefore, Hypothesis 2 was verified.\u003c/p\u003e\n\u003cp\u003eTable 3 Multiple regression analysis results\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"690\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 208px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003eUnethical pro-organizational behavior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eWork meaning\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eM\u003csub\u003e1\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eM\u003csub\u003e2\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eM\u003csub\u003e3\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eM\u003csub\u003e4\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eM\u003csub\u003e5\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eM\u003csub\u003e6\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eM\u003csub\u003e7\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl variables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-0.159\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.070\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.073\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.067\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.027\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.040\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.027\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eTitle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.027\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.040\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003ePosition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.059\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.048\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.119**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.153**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndependent Variables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eServant leadership\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.332**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.236**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.289**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.26**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.407**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMediating variable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eWork meaning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.334**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.236**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModerating Variables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003ePower distance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.285**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.274**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInteraction term\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eServant leadership * Power distance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.216**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cem\u003eR\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.259\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.304\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.192\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cem\u003e△\u003c/em\u003e\u003cem\u003eR\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.103**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.103**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.147**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.246**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.29**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.18**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.629\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e9.056**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e9.004**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e11.325**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e20 .57**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e22.404**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e16.341**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote：** p＜0.01；N=420.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eModerating Role of Power Distance\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study used regression analysis to test the moderating role of power distance between servant leadership and medical staff\u0026rsquo;s work meaning. Model 5 in Table 3 shows that there is a significant positive effect of servant leadership on medical staff\u0026rsquo;s work meaning (b\u0026nbsp;= 0.289, p \u0026lt; 0.01), and Model 6 adds the interaction term between servant leadership and power distance based on Model 5, and the interaction coefficient is significant (b\u0026nbsp;= 0.216, p \u0026lt; 0.01). It indicates that power distance plays a moderating role in the relationship between servant leadership and medical staff\u0026rsquo;s work meaning. Therefore, Hypothesis 3 was validated.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo further analyze whether there was a mediated moderating effect, we used the SPSS Process to calculate the conditional indirect effect and INDEX for different value scenarios of power distance. From the results of the analysis of the conditional indirect effect on the left side of Table 4, it can be seen that when the medical staff power distance was at a low value, one standard deviation below the mean, the indirect effect was 0.009, and the confidence interval at the 95% level was [-0.022,0.043], and since the confidence interval contains 0, this indicates that the indirect effect of servant leadership influencing medical staff\u0026rsquo;s unethical pro-organizational behavior via a work meaning is not significant; when medical staff\u0026rsquo;s power distance is at a high value, one standard deviation above the mean, the indirect effect is 0.115, and the confidence interval at the 95% level is [0.065,0.174], and since the confidence interval does not contain 0, this suggests that the indirect effect of servant leadership via work meaning influencing medical staff\u0026rsquo;s unethical pro-organizational behavior is significant. Consequently, when work meaning serves as a mediating variable, the stronger effect of servant leadership on medical staff\u0026rsquo;s unethical pro-organizational behavior as power distance increases. The right half of\u0026nbsp;Table 4\u0026nbsp;reports the mediated moderating effect determination indicator value INDEX, power distance has a moderating effect on the indirect relationship servant leadership affecting medical staff unethical pro-organizational behavior determination indicator value 0.056 with a standard error of 0.016 and a confidence interval of [0.029,0.090], and since the above confidence intervals do not contain zero, power distance moderates the servant leadership indirect relationship on medical staff\u0026rsquo;s unethical pro-organizational behavior through work meaning. The higher the power distance, the stronger this indirect effect. Hypothesis 4 was tested.\u003c/p\u003e\n\u003cp\u003eTable 4 Results of Bootstrapping analysis with mediated moderated effects\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"135%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 12px;\"\u003e\n \u003cp\u003evariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003econditional indirect effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003eModerated mediation effect\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003emoderator\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003eeffect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e95%LLCI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e95%ULCI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003eINDEX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e95% LLCI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e95%ULCI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003eWork meaning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003elow value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e-0.022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0.056\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003ehigh value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0.115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.027\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.065\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.174\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTo visualize the mediating role of power distance, this study plotted the mediating role of power distance between servant leadership and medical staff\u0026rsquo;s work meaning according to the plotting method recommended by Aiken and West [57]. As can be seen in Figure 2, when power distance is at a high level (mean + 1 standard deviation), it enhances the positive effect of servant leadership on medical staff\u0026rsquo;s work meaning, while when power distance is at a low level (mean - 1 standard deviation), the mediating effect is insignificant in the process of servant leadership\u0026rsquo;s influence on medical staff\u0026rsquo;s work meaning. Hypotheses 3 and 4 were further supported.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eTheoretical Contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFirst, servant leadership is one of the most important triggers for unethical pro-organizational behavior among medical staff.\u0026nbsp;The manager\u0026rsquo;s greater demonstration of servant leadership correlates with an increased propensity among medical staff to engage in pro-organizational behaviors, such as voice behavior [24].\u0026nbsp;The results of the study indicated that servant leadership in hospitals had a beneficial impact on the unethical pro-organizational behavior of medical staff. This indicates that, under specific circumstances, positive leadership may adversely affect organizations, according to the results of analog studies [58].\u0026nbsp;This outcome provides additional evidence about the correlation between positive leadership and unethical pro-organizational behavior.\u003c/p\u003e\n\u003cp\u003eSecond, the work meaning mediated the connection between servant leadership and unethical pro-organizational behavior among medical staff. In recent years, unethical pro-organizational behavior among medical staff has attracted considerable scholarly interest, but a dearth of empirical studies.(59) This study examined the reasons underlying unethical pro-organizational behavior among medical staff through a lens of positive leadership styles informed by cultural values.\u0026nbsp;The research indicated that servant leadership improved work meaning among medical staff, thereby promoting their unethical pro-organizational behavior.\u0026nbsp;This finding reveals the \u0026lsquo;black box\u0026rsquo; of servant leadership influence on medical staff unethical pro-organizational behavior, which may provide insights into the mechanisms that shape unethical pro-organizational behavior and enrich the research literature on work meaning in Management Psychology.\u003c/p\u003e\n\u003cp\u003eLast, this study elucidates the moderating effect of power distance on the indirect relationship between the impact of servant leadership and the unethical pro-organizational behavior of medical staff, shaped by their work meaning. Understanding the boundary conditions of the creation mechanism for unethical pro-organizational behavior among medical staff is essential.\u0026nbsp;The research revealed that individual power distance affected the magnitude of the indirect impact of servant leadership, via work meaning, on the unethical pro-organizational behavior of medical staff. Relative to low power distance, high power distance enhanced the positive influence of servant leadership on medical staff\u0026rsquo;s unethical pro-organizational behavior. This finding not only enriches the research on the moderating variables of unethical pro-organizational behavior but also provides avenues of intervention for preventing and controlling the occurrence of unethical pro-organizational behavior among medical staff. In addition, power distance, asan important cultural value, has seldom been introduced into the study of unethical pro-organizational behavior theory in the past. Therefore, this study goes some way to remedying the lack of emphasis on contextual factors such as cultural values in the study of unethical pro-organizational behavior.\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eManagement Implications\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBased on empirical findings and the fact that unethical pro-organizational behavior is potentially risky for hospitals, the implications of this study for hospital management are as follows: (1)Be alert to the negative impacts of servant leadership. Existing literature focuses on the positive impacts of servant leadership, and many organizations select and develop servant leadership; however, they may have overlooked the dark side of servant leadership. Therefore, hospitals should consider the positive effects of servant leadership, along with the development of proper ethical values and work codes of conduct for medical staff. (2)Strengthening the servant leadership style. Hospitals should carry out style construction in their cadres, strengthen moral cultivation, establish a sense of rules and regulations, promote the Core Values of Chinese Socialism, resolutely oppose all unethical behaviors in hospitals, and prevent unethical behaviors from occurring. (3)Building high-quality superior-subordinate relationships. There are differences in the perceptions and reactions of medical staff to different power distances from their leaders. For medical staff with high power distance, leaders need to be properly guided when they play their role of carrying out orders without compromise and guarding against the occurrence of unethical behavior because of their loyalty to the hospital. Therefore, leaders need to strengthen communication and interaction with their subordinates, build high-quality superior-subordinate relationships, and reduce power distance to prevent unethical behavior. \u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eLimitations and Future Research\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has some limitations. First, it relies on social information processing theory to investigate how servant leadership influences the unethical pro-organizational behavior of medical staff, without taking into account other theoretical perspectives. Future research should use social identity theory to explore the relationship between servant leadership and medical staff\u0026rsquo;s unethical pro-organizational behavior. Second, the survey data were concentrated in public hospitals in Guangdong, Guangxi, Yunnan Province, and Jiangxi Province of China, which may have reduced the external effect of the data. Future research can further improve the sampling region by sampling medical staff in public hospitals from the eastern, central, and western regions according to the economic development of China to improve the external effect of the study. Finally, in conducting the research design of this study, only the cultural value of power distance was considered as a boundary condition for the effect of servant leadership on medical staff\u0026rsquo;s unethical pro-organizational behavior, while organizational-level moderating variables such as organizational ethical climate were not considered; future research could consider introducing organizational-level moderating variables into the research model to more fully understand the formation process of medical staff\u0026rsquo;s unethical pro-organizational behavior.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors made significant contributions to the conception of the article, the design and execution of the study, and the acquisition, analysis, and interpretation of the data. During the creation of the article, the authors all contributed to the drafting process, revising and reviewing the content repeatedly. In the end, the version of the article for publication was unanimously endorsed and approved for submission to the journal. It was also agreed to assume responsibility for the content of the text.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFundings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e2024 Guangdong Pharmaceutical University \u0026ldquo;discipline cultivation, innovation and quality\u0026rdquo; project team project (2024ZR01)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGuangdong Province Philosophy and Social Science Planning Project (GD21CJY02)\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data supporting the findings in this study are available from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of the Business School of Pharmaceutical, Guangdong Pharmaceutical University（Approval number 2022009）. The research process was conducted following the Declaration of Helsinki. The Committee agreed to conduct a questionnaire survey of the medical staff of public hospitals in Guangdong, Guangxi China, etc. The questionnaire was administered with the consent of the respondents to begin the survey, and all respondents participated in this study voluntarily.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors report no competing interests in this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eQiu Y. 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In: Advances in International Comparative Management. 1988. p. 127\u0026ndash;49.\u003c/li\u003e\n\u003cli\u003eAiken LS, West SG. Multiple regression: Testing and interpreting interactions. Thousand Oaks, CA, US: Sage Publications, Inc; 1991. xi, 212 p. (Multiple regression: Testing and interpreting interactions).\u003c/li\u003e\n\u003cli\u003eCao Z, Wang T, Song Y. Do Self-Sacrificing Leaders Promote Employees\u0026rsquo; Unethical Pro-Organizational Behavior? --The mediating role of organizational identification and its effect boundaries. Hum Resour Dev China. 2019;36(6):21\u0026ndash;32.\u003c/li\u003e\n\u003cli\u003eLuo Y, Jiang Y, Li G, Liu R, Zhang H. A study of pro-organizational non-ethical behaviors of healthcare workers from the perspective of performance appraisal goal orientation. J Xinxiang Med Univ. 2018;35(11):1009\u0026ndash;12.\u003cstrong\u003e\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Servant Leadership, Work Meaning, Unethical Pro-organizational Behavior, Power Distance","lastPublishedDoi":"10.21203/rs.3.rs-6429672/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6429672/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eTo examine the mechanism of servant leadership influence on unethical pro-organizational behavior based on social information processing theory.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eConvenience sampling was used to survey the medical staff of more than ten public hospitals in Guangdong and Guangxi provinces of China, 420 valid samples were recovered and the data were analyzed using validation factor analysis, descriptive statistics, multiple regression analysis, and moderated mediated effects analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eServant leadership positively affects medical staff’s unethical pro-organizational behavior; work meaning mediates the relationship between servant leadership and medical staff’s unethical pro-organizational behavior; power distance moderates the indirect effect of servant leadership on medical staff’s unethical pro-organizational behavior through work meaning, and the higher the power distance is, the stronger that indirect impact is.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eGovernment authorities and hospital management need to be alert to the negative effects of servant leadership and consider the positive impact of servant leadership while also fostering correct ethical values and work codes of conduct among medical staff. In addition, communication and interaction between leaders and their subordinates should be strengthened to build high-quality superior-subordinate relationships, reduce power distance, and prevent the induction of unethical behaviors.\u003c/p\u003e","manuscriptTitle":"The effect of Servant Leadership on Medical Staff Unethical Pro-organizational Behavior: The role of Work Meaning and Power Distance ","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-08 17:28:04","doi":"10.21203/rs.3.rs-6429672/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-18T17:09:17+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-13T10:12:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"109661797216538702282823082365901286712","date":"2025-06-06T10:25:21+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-07T06:05:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"211462912041145458433506098639867751766","date":"2025-05-07T05:58:57+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-05T10:02:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-28T11:23:16+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-18T14:43:36+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-18T07:42:41+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-04-18T07:41:35+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ff1aff59-d37c-4f43-bdb6-0e5b9472111c","owner":[],"postedDate":"May 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-10-27T16:39:26+00:00","versionOfRecord":{"articleIdentity":"rs-6429672","link":"https://doi.org/10.1186/s12913-025-13502-1","journal":{"identity":"bmc-health-services-research","isVorOnly":false,"title":"BMC Health Services Research"},"publishedOn":"2025-10-24 16:16:10","publishedOnDateReadable":"October 24th, 2025"},"versionCreatedAt":"2025-05-08 17:28:04","video":"","vorDoi":"10.1186/s12913-025-13502-1","vorDoiUrl":"https://doi.org/10.1186/s12913-025-13502-1","workflowStages":[]},"version":"v1","identity":"rs-6429672","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6429672","identity":"rs-6429672","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}