This paper examines the relationship between labor-management partnership (LMP) and employee voice in the healthcare setting. We argue that the ability of LMP to deliver gains to employees is contingent on the quality of the procedural infrastructure on which it is established. We maintain that the quality of LMP processes influences employee trust in their employer and perceptions of union effectiveness and that these perceptions, in turn, are related to employee patientcare voice.

Purpose -The purpose of this study is to examine the direct and indirect effect of high and low-level local union leaders on various forms of member participation. Design/methodology/approach -Interviews and surveys of the leaders and members of an Educators Association operating in the USA were used to explore these complex relationships. Multiple regression, hierarchical regression, and path analyses were used to test direct and indirect relationship and the amount of variance explained by participatory leadership. Findings -Survey results indicate that a member's perception of the participatory style of the local union president positively related to, and explained a significant amount of additional variance in, union activities that require moderate and high levels of effort. No support was found for the workplace representative's direct relationship with various measures of member participation. The indirect effects of the union president's and the workplace representatives' participatory style on union involvement highlight the importance of various union leadership roles on developing various union attitudes. Research limitations/implications -Limitations include the cross-sectional nature of the study, common method bias, and a small sample size (N ¼ 113). Practical implications -Results of the study highlight the importance of the union president in fostering union attitudes and certain forms of union participation. The findings suggest areas for leadership development and training opportunities of union officials. Originality/value -Unique elements of the study include an exploration of multiple leadership roles on union attitudes and various forms of union participation.

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