Voice through exit: Changing working conditions by independent contractors’ participation

Abstract

In the course of worldwide reforms in health care systems, flexible employment is of increasing relevance in medicine and also includes the highly skilled workforce of hospital physicians. With reference to Hirschman’s seminal work on exit, voice and loyalty, this article analyzes the phenomenon of deploying locum tenens physicians as independent contractors in hospitals. The results of two qualitative empirical studies drawing on 30 qualitative interviews show conditions and consequences of exit– voice– loyalty behavior on different levels. On the meso level of organizations, locum tenens physicians help to enforce improvements in everyday hospital practices because as independent contractors, they gain a new, more autonomous position – they receive voice through exit.

Voice in non-traditional employment relationships: a review and future research directions

“…They argued that both workers in TERs and NTERs are less likely to display a reasonable degree level of influence in management decisions and actions. Surprisingly, Ruiner et al (2020) found independent consultants in the health sector having a higher degree of influence than permanent physicians. They argued that the independent consultants could influence management actions by voicing due to expertise, freedom, and loyalty to professional values.…”

“…Direct voice was the most common form of voice among non-traditional workers (see Goñi-Legaz & Ollo-López, 2017;McDonnell et al, 2014). Among professionals in disguised or dependent self-employment, an informal pattern of worker participation was reported (Ruiner et al, 2020). Daily walk-around conversations, in-depth conversations between individual employees and managers, suggestion schemes, electronic mails, staff surveys, social networking sites, installed support software are the direct forms of voice reported (see Gegenhuber et al, 2021;Good & Cooper, 2014).…”

“…Studies (n = 8) (e.g. Ruiner et al, 2020) identified shared issues as dominant. This is due to the shared issues' integrative nature against the contested concerns' distributive nature.…”

“…Soltani et al, 2018;Yang, 2012) reported low level of upward communication among temporary employees, part-timers, temporary agency workers, even where they have access to collective voice (Wood, 2016). In contrast, Donnelly et al (2012), Ruiner et al (2020), andMcDonnell et al (2014) reported that temporary employees, independent contractors, and part-timers could offer suggestions, air their ideas about workplace issues, and complain about issues that affect them. Identified issues include-holiday/work timing, work tasks, pay and benefits, work conditions, and training needs (Donnelly et al, 2012).…”

“…Most studies reviewed found workers in NTERs having little or no influence over workplace decisions due to power imbalance (Wood, 2016), nature of their contract/job and industry (Ruiner et al, 2020). However, McDonnell et al (2014 argued that part-time employees influence lower-level workplace decisions and accept wittingly their inability to influence higher-level management decisions.…”