Speaking up with passion: Voice, leadership, and helping behavior in public organizations

Healthcare delivery depends not only on technical expertise but also on the willingness of clinicians to speak up and to support one another in demanding environments. Drawing on Self-Determination Theory, this study explores how prosocial voice fosters helping behavior through the energizing role of work passion, and how ethical leadership shapes this process. Using a three-wave, multi-source design, we obtained 306 matched employee-leader dyads from public hospitals. Structural equation modeling demonstrated that prosocial voice enhanced work passion, which in turn predicted helping behavior. Mediation analysis confirmed the indirect effect, while moderation results revealed that ethical leadership amplified the passion-helping relationship, producing a significant conditional indirect effect. These findings extend theoretical work by positioning passion as a motivational mechanism that explains how voice translates into prosocial outcomes, and by showing that ethical leadership provides the contextual support necessary for this process. These results provide practical guidance for strengthening supportive climates and leadership practices that enable clinicians' discretionary contributions.