REPORT Health and Social ProgramsHealthcareUnionsUnited States

Institutional Legacies, Union Power, and Organizational Restructuring in Healthcare


January 2019, Rosemary Batt, John Kallas, and Eileen Appelbaum

A central problem in contemporary employment relations has been the fragmentation of work and dismantling of internal employment systems that historically provided stable jobs and income security. This process is occurring in hospital systems as they attempt to cut costs and improve care quality by shifting services out of costly hospitals and into a wide range of outpatient centers. While these strategies may benefit patients, the implications for workers and their unions are worrisome as decentralization leads to the unravelling of internal employment systems and the potential creation of two-tiered or segmented labor markets across different locations in the same city.

Some unions, however, have been able to resist management concessions and maintain inclusive employment systems that protect all members. What explains this variation in union success? We address this question by drawing on a matched case comparison of healthcare unions operating in two US cities in the same region: Buffalo and Rochester, New York. The cities share many similarities, but healthcare unions in Buffalo have succeeded in expanding union power and representation while those in Rochester have not. We draw on institutional and power resources theory to show how deep differences in historical legacies of labor management relations have shaped the capacities of unions in the two cities to confront employer power.

PPTX powerpoint logo | Flash 

For a copy of the full report, available as a PDF, please email appelbaum[at]cepr.net and reference the paper’s title. The PDF will be sent as an attachment in the reply.


    Support Cepr

    If you value CEPR's work, support us by making a financial contribution.