Differential impacts of internal and external corporate social responsibility on emotional labor among clinicians in Chinese public hospitals: A cross-sectional study.

Chinese clinicians face significant emotional labor challenges due to an imbalance in the doctor-patient ratio, long working hours, high regional work stress, and cultural expectations. While research on the relationship between corporate social responsibility (CSR) and emotional labor has grown, the specific impact of internal versus external CSR remains unclear. This study aims to explore the differential effects of internal and external CSR on emotional labor, organizational identification (OI), and perceived social support (PSS) among Chinese clinicians, providing insights into how these factors interact to affect clinicians' emotional well-being. We surveyed clinicians in grade 3A public hospitals across China. Using PLS-SEM with Smart-PLS4, we analyzed 350 valid responses to examine the relationships between internal and external CSR, emotional labor, OI, and PSS. Our findings confirmed that internal CSR negatively affects surface acting and positively affects deep acting (DA), indicating that organizational support fosters authentic emotional engagement rather than superficial emotional responses. The mediating role of OI was also validated, with internal CSR enhancing clinicians' identification with the organization, reducing emotional dissonance. However, external CSR did not significantly affect either surface or DA, suggesting that social responsibility outside the organization may not directly alleviate emotional labor. The moderating role of PSS was only partially supported, with social support buffering some of the negative effects of emotional labor but not all. This study is significant for policymakers and healthcare managers, as it highlights the critical role of internal CSR in reducing emotional labor among clinicians. The findings suggest that organizations should focus on internal social responsibility practices (such as fostering a supportive work environment and enhancing OI ) to reduce surface acting and promote DA. By doing so, hospitals can create a more sustainable work environment for clinicians, improving their well-being and reducing burnout.