Health and Safety as Commodities - Loyalty, Voice, and Exit

In 2007, a proposal in The US State of South Carolina suggested prisoners receive sentence reductions in exchange for donating organs or bone marrow. This raised an ethical question: Should health be treated as a commodity, where access and decisions are influenced by market principles? If so, who gets left behind? The poor and the powerless, of course!

We can ask the same questions for health and safety in organizations. The health and safety of workers are often subordinated to the demands of profit-driven systems (Brinkmann, 2011). Because of law reforms, deregulation and market efficiency cost-cutting is prioritized over employee well-being. Workers who are faced with physical and mental strain sometimes hesitate to raise safety concerns due to financial incentives or fear of retribution. But collective resistance through unions and worker advocacy provides opportunities to challenge this commodification of health.

Exit, Voice, and Loyalty

To see what’s going on here, we can use Albert Hirschman’s terms Exit, Loyalty, and Voice. Ulrich Brinkmann applied these to coordination logics, particularly in the context of changing market boundaries within companies (Brinkmann, 2011):

-           Exit organizations are those in which market-centric logic dominates. Employees, stakeholders, or consumers respond to dissatisfaction by leaving the organization or discontinuing their involvement. The organization itself encourages this by implementing mechanisms like internal markets, outsourcing, or performance-based evaluations, where each internal unit operates somewhat autonomously and may exit from others if efficiency demands it.

-           Voice organizations lay a strong emphasis on participation, dialogue, and democratic involvement (co-determination). Employees in these organizations have mechanisms to express dissatisfaction or suggest improvements without resorting to exit. This organization type is most aligned with employee representation systems like works councils or unions, which provide formal and informal platforms for expressing concerns and influencing decisions.

-           Loyalty organizations value commitment, long-term relationships, and a shared culture or identity. Employees in these organizations are encouraged to remain loyal to the company, even in the face of dissatisfaction, by appealing to their sense of belonging or commitment to the organization’s goals. Loyalty organizations rely mainly on cultural or emotional appeals to keep employees committed, even when other aspects of the organization might push them to leave.

 Culture Club - Corporate culture in market-centered organizations

Corporate culture emerged as a unifying force (loyalty) in the 1980s and has since been co-opted by management for control rather than genuine participation (voice). With the rise of shareholder value thinking (exit), the focus went from employee engagement to short-term financial outcomes. Internal markets within companies have further destabilized loyalty and cohesion, so organizations are forced to find new ways to maintain internal unity.

No organization purely follows one of the three logics Exit, Voice and Loyalty. Overlaps and tensions always exist. When one of the logics encroach on the sphere of voice, the possibility for genuine democratic participation becomes weakened. This creates risks for employees but also opens up opportunities for resistance and advocacy for more sustainable, participatory workplace practices. The challenge for organizations is finding a balance between these competing logics, particularly in a market-driven environment where short-term gains (exit logic) can undermine long-term loyalty and voice-oriented participation.

 The dominance of market mechanisms (exit) can be mitigated by hybrid participation models (voice) that integrate employee autonomy and decision-making. By involving knowledgeable employees in decision-making processes, organizations aim for sustainable collaboration and informed decision-making, but the long-term impact remains to be seen.

 Do learning teams improve ‘Voice’?

The now popular ‘learning teams’ are an example of a hybrid participation tool. Learning teams are collaborative groups that focus on knowledge sharing, problem-solving, and continuous improvement within the workplace. Their original purpose is to strengthen the voice of employees, which allow for deeper engagement in decision-making processes about workplace health and safety issues.

By organizing into learning teams, employees gain a structured, empowered role in organizational discussions, aligning with the hybrid forms of employee involvement that combine direct participation with co-determination. Learning teams could provide a platform for employees to openly discuss and address workplace health issues, thereby countering the commodification of health by prioritizing well-being over mere cost-efficiency.

But as with any tool, implementation can bring along unexpected consequences. For instance, employee participation (voice) can remain symbolic (loyalty) instead of impactful. Shifts in market boundaries often erode genuine participatory practices, replacing them with selective, instrumental approaches. Without steadfast top management commitment, and proper institutionalization, even learning teams will probably quickly fade into insignificance. Especially when the loyalty organization gets the upper hand with the next wave of culture initiatives. If this will lead to an ‘exit’ - of people with the best possibilities at least - is an open question.

References:

-       Brinkmann, U. (2011), Die unsichtbare Faust des Marktes - Betriebliche Kontrolle und Koordination im Finanzmarktkapitalismus, Berlin: edition sigma.

-       Hirschman, A.O. (1986), Exit and Voice: An expanding sphere of influence, in: Rival Views of Market Society and Other Recent Essays, Cambridge: Harvard University Press.