Purpose The purpose of this study is to understand the conditions in which subordinates, after making a mistake, are more likely to engage in feedback avoidance behaviour (FAB), a set of behaviours that could ultimately jeopardise patient safety in a health care context. Design/methodology/approach This study used a sample of 183 independent leader-subordinate dyads in the health care service sector. For this study, a multiple mediator model in which three types of conflict (task conflict, relationship conflict and process conflict) were tested and acted as mediating mechanisms that transmitted the effects of perceived dissimilarity to FAB. Findings The results supported the mediating role of two of the three forms of conflict and highlighted the consequences of dissimilarity between supervisors and subordinates in the healthcare setting. Research limitations/implications One of the noteworthy limitations of this study was that this study used cross-sectional time-lagged data. Future research should use a more rigorous longitudinal approach such as a cross-lagged design (Whitman et al., 2012) to explore the dynamic nature of dyadic relationships over time. Practical implications An important implication of our study results suggests that health care leadership development training should provide opportunities to increase awareness of the tendency of leaders to treat subordinates perceived as dissimilar more negatively. Originality/value These results contribute to our understanding of the interpersonal processes between subordinates and their supervisors, which could have a significant impact on organisational outcomes in the health care setting.