Relationship Between Psychological Contract Violation and Physicians’ Destructive and Constructive Behaviors in Tertiary Public Hospitals: An Empirical Evidence in Beijing

BACKGROUND: In China, physicians have long faced long working hours, high stress levels, and tensions between physicians and patients, which can lead to negative behaviors. Understanding physicians’ expectations and requirements of the hospital and increasing satisfaction with their psychological contract can help improve physician motivation and stabilize the hospital team. AIM: The study aims to analyze the relationship between physicians’ psychological contract violations and different behavioral choices, encourage hospitals to conclude a balanced psychological contract with physicians, and provide governance and intervention strategies for hospital human resource management. METHODS: Stratified cluster sampling was used to select 321 physicians from four public hospitals in Beijing for questionnaire surveys. Descriptive statistical analysis, t-test, ANOVA, correlation analysis, and regression models were performed using Stata 15.0 and SPSS 26.0 to analyze the relationship between psychological contract violations, physicians’ EVLN behaviors and organizational justice. RESULTS: Psychological contract violation had a positive effect on exit behavior and neglect behavior, and a negative effect on voice behavior and loyalty behavior. Organizational justice plays a mediating role between psychological contract violation and physicians’ exit, voice and loyalty behaviors. CONCLUSION: Psychological contract violation can drive negative behavior among physicians, and organizational justice can play a mediating role in this. Public hospitals should establish a healthy psychological contract with physicians and place a premium on organizational justice to promote constructive behaviors and prevent destructive behaviors. This study constructs a more complete theoretical framework to explain physicians’ behavior, and further dynamic tracking investigations are necessary because the evolution of physicians’ behavior is a dynamic and long-term process.