When Caregivers Feel Dehumanized: Exploring Political Behavior through Perceived Injustice in Pakistani Healthcare Settings

Abstract

Pakistan’s healthcare sector operates under persistent structural and managerial pressures, including resource scarcity, workload intensity, professional hierarchy, limited employee voice, and unequal decision-making power. In such conditions, perceived injustice becomes more than a routine workplace concern; it can trigger political and deviant employee responses that weaken teamwork, service quality, employee dignity, and organizational trust. Drawing on Social Exchange Theory, this study examined whether perceived injustice leads to deviant workplace behavior through political behavior and whether Machiavellianism strengthens this relationship in Pakistan’s healthcare sector. The study also connects this issue with the Sustainable Development Goals, particularly SDG 3: Good Health and Well-being, SDG 8: Decent Work and Economic Growth, and SDG 16: Peace, Justice and Strong Institutions, because fair and accountable healthcare workplaces are essential for employee well-being, ethical service delivery, and institutional trust. The study adopted a positivist, deductive, quantitative, and cross-sectional research design. Data were collected through personally administered questionnaires from doctors, nurses, paramedical staff, technicians, and administrative employees working in Pakistan’s healthcare sector. Out of 384 distributed questionnaires, 202 valid responses were retained after removing incomplete, missing, and biased responses. Established scales were used to measure perceived injustice, political behavior, deviant workplace behavior, and Machiavellianism. The findings supported the proposed moderated-mediation model. Perceived injustice significantly predicted political behavior (β = 0.43, p < .001), indicating that unfair treatment encouraged employees to engage in informal and self-protective workplace politics. Political behavior significantly predicted deviant workplace behavior (β = 0.51, p < .001), confirming that workplace politics can become a pathway toward harmful conduct. The indirect effect of perceived injustice on deviant workplace behavior through political behavior was significant (effect = 0.22, Boot SE = 0.05, LLCI = 0.13, ULCI = 0.33). Machiavellianism also significantly moderated the relationship between perceived injustice and political behavior (β = 0.19, p < .001). The conditional indirect effect increased from 0.11 at low Machiavellianism to 0.36 at high Machiavellianism, and the index of moderated mediation was significant.