Trust bridges engagement and citizenship behavior in Saudi private healthcare, study finds

Employee engagement appears to encourage organizational citizenship behavior—the discretionary, unpaid extra efforts employees make at work—and a new study from Saudi Arabia’s private healthcare sector suggests that trust is a key part of how that happens. The research, based on a survey of 232 healthcare employees, reports that engaged workers are more likely to go beyond their formal job duties both directly and indirectly, with trust in their supervisor and trust in the organization acting as stepping stones between the two.

The study, conducted by researchers including Elamin, Ahmed, Aldabbas and Gernal and set for publication in Frontiers in Health Services, tested a conceptual model using partial least squares structural equation modeling (PLS-SEM), a statistical technique commonly used to examine how multiple psychological variables relate to one another in survey data. The authors grounded their model in three established theoretical frameworks: Social Exchange Theory, which frames workplace relationships as reciprocal exchanges; Leader–Member Exchange Theory, which focuses on the quality of the relationship between employees and their direct supervisors; and Trust Transfer Theory, which describes how confidence in one authority figure can extend to the larger institution that person represents.

According to the reported findings, employee engagement positively influenced organizational citizenship behavior both directly and indirectly through the two forms of trust examined. Supervisor trust also showed a significant positive effect on organizational trust, a pattern the authors describe as a cascading trust transfer: employees who trust their immediate managers appear to generalize that confidence to the healthcare organization as a whole. In the model, this chain ran in parallel and serial pathways, meaning trust in the supervisor and trust in the organization each mediated the engagement–citizenship link, and the two forms of trust could also operate in sequence.

The model explained 54.5% of the variance in organizational citizenship behavior, which the authors characterize as strong explanatory power for a behavioral outcome of this kind. The study addresses a gap the authors identify in the organizational behavior literature: while engagement is widely known to influence citizenship behavior, the multilevel trust mechanisms underlying that relationship, particularly in healthcare settings, have remained underexplored. By integrating supervisor-level and organization-level trust processes within a single framework, the study links engagement to discretionary workplace behaviors through an explicitly layered mechanism.

The authors situate their findings within Saudi Arabia’s Vision 2030 healthcare transformation agenda and offer evidence-based recommendations to strengthen leadership, trust, and employee engagement in order to improve workforce performance and service excellence. As with any cross-sectional survey study, the results reflect associations measured at a single point in time among employees in one sector and one country, and the reported relationships are statistical patterns rather than proof of causation. The claims expressed are those of the authors and do not necessarily represent those of their affiliated organizations or the publisher.

Subject of Research: The mediating role of supervisor and organizational trust in the relationship between employee engagement and organizational citizenship behavior in Saudi Arabia's private healthcare sector.

Article Title: How trust shapes the relationship between employee engagement and organizational citizenship behavior: evidence from Saudi Arabia's private healthcare sector

Article References: Elamin, A. M., Ahmed, A. Z. E., Aldabbas, H., & Gernal, L. (2026). How trust shapes the relationship between employee engagement and organizational citizenship behavior: evidence from Saudi Arabia's private healthcare sector. Frontiers in Health Services, 6, Article 1958907. https://doi.org/10.3389/frhs.2026.1958907

Image Credits: AI Generated

DOI: 10.3389/frhs.2026.1958907

Keywords: employee engagement, organizational citizenship behavior, supervisor trust, organizational trust, trust transfer, healthcare workforce, Saudi Arabia, private healthcare sector, PLS-SEM, Vision 2030, organizational behavior, trust