Edinburgh Napier University

  Purpose
The purpose of the paper is to examine how perceived organizational support (POS) for physicians is situated within different hospital physician relationship (HPR) employment structures and to explore human resource development (HRD) implications within these relationships.

Design/methodology/approach
This paper focuses on research in the western context using an integrated literature review methodology, which includes employed (“Employed”), affiliated (“Affiliated”) and Locum tenens physicians [“Locum(s)]” who work in hospitals.

Findings
POS constructs, under the broader purview of organizational support theory (OST), provided evidence for hospital leadership to find intentional ways to support their hospitals physicians within all HPR models. Our review also revealed the strategies adopted by hospitals to align and influence physician practice behaviors, which were researched using economic and/or noneconomic constructs. The findings indicated stronger or isolated alignment with hospitals where the physicians practiced.

Research limitations/implications
The paper focuses on Employed, Affiliated and Locums HPRs in western healthcare contexts. When available, distinctions are made with respect to the US or Europe. Limitations to our review include (a) limited research within healthcare contexts on organizational support, and (b) limited literature about Affiliated and Locums hospital physician populations in the US and Europe written in English.

Practical implications
Though hospital physicians are integral to patient care and economic efficiencies in hospitals, not much is known about how hospital physicians perceive organizational support within different HPRs, and what construct contributions are made to hospital system performance. Accordingly, this study contributes to the HRD literature in the healthcare context starting with confirming HPRs from a POS perspective and extending findings to theories of employee alignment that can contribute to organizational performance. The findings of this study serve HRD theory and practice. Theorists may use this to pursue HPR-related inquiries to explore HRD’s influence in creating hospital policies and culture that make physicians feel supported and satisfies the hospital’s financial and patient care-related goals. Practitioners may use the findings of this article to inform quality improvement and organization development efforts.

Social implications
Hospital physicians are an integral workforce that provides critical patient care across the world. Understanding how organizations can support physicians has a ripple effect from hospitals to communities at large.

Originality/value
This review contributes toward the development of a conceptual model of organizational support for HRD that can help physicians and their hospital employees within different HPRs to reach mutual goals of support, understanding, integration (clinical, economic and noneconomic) and physician alignment evidenced by improved patient care and organizational performance.