Voice through exit: Changing working conditions by independent contractors’ participation
基于Hirschman的退出-发言-忠诚理论，通过30个定性访谈分析医院临时医生作为独立承包商的现象，发现他们通过退出获得更自主的地位，从而推动日常医院实践的改进。
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.