title: The impact of professional and organizational identification on the relationship between hospital-physician exchange and customer-oriented behaviour of physicians.
abstract: BACKGROUND
  Hospitals face increasingly competitive market conditions. In this challenging environment, hospitals have been struggling to build high-quality hospital-physician relationships. In the literature, two types of managerial strategies for optimizing relationships have been identified. The first focuses on optimizing the economic relationship; the second focuses on the noneconomic dimension and emphasizes the cooperative structure and collaborative nature of the hospital-physician relationship. We investigate potential spillover effects between the perceptions of physicians of organizational exchange and their customer-oriented behaviors.
  
  
  METHODS
  A cross-sectional study was conducted on 130 self-employed physicians practicing at six Belgian hospitals. Economic exchange was measured using the concept of distributive justice (DJ); noneconomic exchange was measured by the concept of perceived organizational support (POS). Our outcomes consist of three types of customer-oriented behaviours: internal influence (II), external representation (ER), and service delivery (SD).
  
  
  RESULTS
  Our results show a positive relationship between DJ and II (adjusted R(2) = 0.038, t = 2.35; p = 0.028) and ER (adjusted R(2) = 0.15, t = 4.59; p < 0.001) and a positive relationship between POS and II (adjusted R(2) = 0.032, t = 2.26; p = 0.026) and ER (adjusted R(2) = 0.22, t = 5.81; p < 0.001). No relationship was present between DJ (p = 0.54) or POS (p = 0.57) and SD. Organizational identification positively moderates the relationship between POS and ER (p = 0.045) and between DJ and ER (p = 0.056). The relationships between POS and II (p = 0.54) and between DJ and II (p = 0.99) were not moderated by OI. Professional identification did not moderate the studied relationships.
  
  
  CONCLUSIONS
  Our results demonstrate that both perceptions of economic and noneconomic exchange are important to self-employed physicians' customer-oriented behaviours. Fostering organizational identification could enhance this reciprocity dynamic.
authors.affiliation: Department of Public Health, Ghent University, Ghent, Belgium. jeroen.trybou@ugent.be.
authors.forename: Jeroen
authors.initials: J
authors.lastname: Trybou
authors.affiliation: Department of Public Health, Ghent University, Ghent, Belgium. gaelle.decaluwe@ugent.be.
authors.forename: Gaelle
authors.initials: G
authors.lastname: De Caluwé
authors.affiliation: Department of Innovation, Entrepreneurship and Services Management, Ghent University, Ghent, Belgium. katrien.verleye@ugent.be.
authors.forename: Katrien
authors.initials: K
authors.lastname: Verleye
authors.affiliation: Department of Innovation, Entrepreneurship and Services Management, Ghent University, Ghent, Belgium. paul.gemmel@ugent.be.
authors.forename: Paul
authors.initials: P
authors.lastname: Gemmel
authors.affiliation: Department of Public Health, Ghent University, Ghent, Belgium. lieven.annemans@ugent.be.|Faculty of Medicine and Health Sciences, Vrije Universiteit Brussel, Brussels, Belgium. lieven.annemans@ugent.be.
authors.forename: Lieven
authors.initials: L
authors.lastname: Annemans
mesh_terms: D001291:Attitude of Health Personnel; D001519:Behavior; D001530:Belgium; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D004651:Employment; D006761:Hospitals; D006801:Humans; D007400:Interprofessional Relations; D007588:Job Satisfaction; D009938:Organizations; D017060:Patient Satisfaction; D010465:Perception; D010820:Physicians; D040841:Resource Allocation