Physician-Hospital Exchanges: The moderating effects of the Chief
Medical Officer.
Trybou J., Gemmel P., Annemans L.
Abstract:
Context: Because of continuously rising healthcare expenditures and concerns about the
quality of care, hospitals find themselves at the locus of the reform debate. Against this
background, hospital executives are charged with the development of organizations in which
high-quality care is efficiently delivered in an increasingly competitive environment.
Physicians hold a centrally important function in hospitals and are critical to hospitals’
organizational success. In this study we focus on the influence of medical leaders on
physicians’ perceptions of physician-hospital exchanges. More precisely, we address the
quality of the relationship between self-employed physicians and the Chief Medical Officer
as a potential moderator.
Methods: A quantitative cross-sectional survey was conducted on 130 self-employed
physicians practicing at 6 Belgian hospitals (17.1 % response rate). To measure economic
exchange the concepts of Distributive Justice (DJ) and Procedural Justice (PJ) were applied to
the contractual relationship between physician and hospital. Noneconomic exchange was
conceptualized ad measured by the construct of the Psychological Contract. A distinction was
made between an administrative and a professional dimension. Our outcomes comprise key
organizational attitudes (satisfaction, affective commitment and intention to leave) and two
types of organizational citizenship behaviour: Direct Personal Participation (DPP) and
Indirect Stimulating Involvement (ISI) when hospital improvement initiatives are considered.
The moderating role of the quality of exchange with the Chief Medical Officer (LeaderMember eXchange CMO) in the relationships of (distributive and procedural) organizational
justice and (administrative and professional) psychological contract breach and physicians’
key organizational attitudes and OCBs was assessed.
Results: Our results showed a relationship between both psychological contract breach and
organizational justice and physicians’ organizational attitudes. In contrast to organizational
justice, no relationship was found between psychological contract breach and OCBs. Quality
of exchange with the CMO buffered the negative effect of psychological contract breach and
reinforces the positive effects of organizational justice with respect to physicians’
organizational attitudes. When OCBs are considered, only a relationship with organizational
justice was present which was moderated by the quality of exchange with the CMO.
Remarkably, physicians who experience low levels of LMX were less affected by perceptions
of justice, whereas the work behaviors decreased as justice decreased among physicians that
experience high levels of LMX. A detailed overview of the results is provided in the
appendix.
Discussion: Our results demonstrate that physician leadership is of major importance to
physician-hospital exchanges. Both economic and noneconomic aspects are important when
considering physicians’ key organizational attitudes. However, with respect to organizational
citizenship only the economic dimension of exchange was found to be significant. The
reciprocity dynamic can be enhanced by high-quality exchange with the CMO. Our findings
highlight the need for additional research. In particular, since different types of OCB exist it
would be valuable to consider the potential differences between the types of extra-role
behavior. More specifically, given the centrally important clinical role of medical doctors and
their corresponding impact on hospital performance this presents an interesting avenue for
future research.
Keywords: Organizational Justice, Psychological Contract, Hospital-Physician Relationships,
Satisfaction, Affective Commitment, Intention to Leave, Chief Medical Officer
Jeroen Trybou is academic assistant at Ghent University. His PhD research focuses on the
hospital-physician relationship. He acts as advisor for several Health Care organizations and
is guest lecturer Health Care Management & Policy at the University-College Brussel. His
key research interests include organizational and financial aspects of Health Care delivery.
Paul Gemmel is professor of Health Care & Service Management at the Faculty of Economics
and Business Administration of Ghent University. He is also Senior Research Fellow at the
Vlerick Leuven Ghent Management School. He has published widely in the area of Health
Care and Service Management.
Lieven Annemans is full professor of Health Economics (I-CHER) at Ghent University and Brussels
University (VUB). He is past-president of the International Society of Pharmacoeconomics and
Outcomes Research (ISPOR) and is currently a member of the Flemish strategic council for health and
wellbeing. His research focuses on Health Economic evaluations and Health Policy. He has published
more than 150 peer-reviewed articles in this domain.