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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.    Conclusion  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.

human resources for health

The impact of professional and organizational identification on the relationship between hospital–physician exchange and customer-oriented behaviour of physicians