We develop a conceptual model of customer-focused voice and test it in a hospital setting. Drawing from theory and research on voice, we find that customer orientation and job autonomy are positively associated with customer-focused voice. In addition, consistent with social information processing theory, these relationships are moderated by service climate, such that a high service climate compensates for the less desirable aspects of employees or their jobs. Finally, we provide evidence for a critical but untested assumption of the voice literature by linking hospital-level customer-focused voice to hospital-level service performance. Results based on data from four unique data sources, provided at varying points in time, and at different levels of analysis demonstrate support for our conceptual model.