Competition between unions whose membership has different skills and professionalization levels i... more Competition between unions whose membership has different skills and professionalization levels is a long-standing issue in the labour movement. This article investigates the conditions for why and how a unique cross-professional coalition of all Danish public-sector unions developed between 2017 and 2018. Operating in a favourable context, unions overcame professionalization differences when skilled brokers primed a common instrumental base as other unionists used a public interest frame to legitimate the coalition and its demands ideologically. However, once the common instrumental concern was met, the coalition collapsed. The article argues that union coalition-building depends on multiple factors comprising both contextual, and identity and relational conditions. The article further argues that adopting a framing that focuses on the public interest over professional self-interest helps to successfully overcome professional cleavages.
Drawing on comparative employment relations literature, this article explores how employment rela... more Drawing on comparative employment relations literature, this article explores how employment relations (ER) institutions support the ‘care coordinator’, a new role tasked with aiding the exchange of information between health and social services in the United States and the UK. Findings show that in both countries, multi-employer collective bargaining facilitated this role by providing good working conditions and a stable work environment; additionally, the new role performed better in England due to the broader scope of bargaining and supportive management practices. The article advances a comparative institutional perspective on the creation of new tasks focused on sub-national (sectoral and regional) ER.
The lack of an efficient support system for people with multiple, long-term health conditions has... more The lack of an efficient support system for people with multiple, long-term health conditions has increased costs, worsened health outcomes, and prompted policymakers to implement a boundary-spanning role within healthcare settings. While scholars have demonstrated the benefits of coordination roles and other such high-performance work practices (HPWPs) in this sector, the actual implementation of these practices is less clear. Based on a comparative case study approach, 153 interviews, and other qualitative data, this article explores frontline managers' HR philosophies and practices (‘frontline HRM relationality’) to explain possible variation in efforts to implement the boundary-spanning role of care coordinators (CCs). Despite strong policy support for the role, coordination has improved unevenly because of varying degrees of HRM relationality: findings show that higher frontline HRM relationality was associated with lower inter-occupational professionalization differences and higher boundary-spanning coordination. The article contributes to a nascent literature on HPWP implementation by theorizing frontline HRM relationality as a continuum that moderates professionalization-related coordination problems and highlights the importance of frontline HRM relationality for implementing HPWPs in professionalized settings.
The management of the professions has become increasingly challenging, reflecting the emergence o... more The management of the professions has become increasingly challenging, reflecting the emergence of new work roles in professionalized workplaces. Human Resource Management (HRM) scholars have, however, been slow to study the professions, particularly how the power they derive from ownership interacts with other forms of power. This article explores the use of different forms of power by a profession, general practitioners (GPs), in engaging with a new healthcare role, the physician associate (PA). Despite policy support for the role, we find GPs' employment of the role in primary care is low. This is explained by two GP responses to the introduction of the role: employment denial and subordination. We theorize these responses as deriving from GPs' ownership power, enhancing their managerial and knowledge-based control over PAs. In doing so, we open-up a research avenue in the study of workforce management focused on professions' ownership power.
Policymakers now have four decades' experience using marketization to address cost and quality pr... more Policymakers now have four decades' experience using marketization to address cost and quality problems in public-sector health services. While much is known about the challenges, it is difficult to draw lessons because there remains no agreed-upon definition of marketization. This article contributes a definition that focuses on the transaction, particularly the effects of funding arrangements on the intensity of competition among providers. Based on prior literature and 106 interviews with practitioners and researchers in five countries, the authors contribute a systematization of 12 concrete market mechanisms enacting three market principles. Furthermore, the authors analyze respondents' perceptions of healthcare marketization's effects on costs and quality. While marketization is a multifaceted, sometimes ambiguous phenomenon requiring further research before definite conclusions can be reached, most statements from our respondents about cost and quality effects were negative. Evidence for Practice • Examining health systems in five countries, we identify 12 different market mechanisms, i.e. concrete procedural changes that stimulate competition among service providers. • While these mechanisms sometimes enable improvements in cost and quality, our respondents identified many more examples of markets driving up costs and compromising quality. • A substantial number of respondents also stated that effects were unclear. • More research is needed to assess the effects of market mechanisms in healthcare, for which the article's conceptualization and findings can serve as a basis.
Part of an edited volume on mobilizations in hospitals called "Krankenhäuser in Bewegung. Interna... more Part of an edited volume on mobilizations in hospitals called "Krankenhäuser in Bewegung. Internationale Kämpfe für gute Versorgung und Arbeitsbedingungen"; edited by Julia Dück and Stefan Schoppengerd; published by the Rosa-Luxemburg-Stiftung, Berlin. The full, German language volume is available here: https://www.rosalux.de/publikation/id/43510/krankenhaeuser-in-bewegung-1?cHash=7d3c1d164e3e827f5f4b141e9c2e5128
Short Piece on COVID-19 in: In Critical Solidarity, Vol. 19, Issue 1. Newsletter of the American ... more Short Piece on COVID-19 in: In Critical Solidarity, Vol. 19, Issue 1. Newsletter of the American Sociological Association's Labor and Labor Movements Section. Available under: https://asalabormovements.weebly.com/newsletter.html
Governments world-wide have attempted to use market mechanisms and privatisation to increase the ... more Governments world-wide have attempted to use market mechanisms and privatisation to increase the quality and/or reduce the cost of healthcare. England's Health and Social Care Act 2012 is an attempt to promote privatisation through marketisation in the National Health Service (NHS). While the health policy literature tends to assume that privatisation follows from private-sector entry points, we argue that this is more likely if firms expect to make a profit. This paper examines the link between privatisation and marketisation in England drawing on 32 semi-structured interviews with private-sector and public-sector respondents, campaigners, and other experts conducted 6-10 months after the implementation of the 2012 Act. By generating a theoretical framework on the conditions of profitability we seek a better understanding of the conditions under which marketisation leads to privatisation. We find that significant barriers to profit-making remain after the reforms, including a top-down squeeze on prices, uncertainty in market rules, state dominance of funding and provision, and failures to depoliticise the market. These factors restrict private-sector involvement by frustrating profit-making. Where profits are made they are through reduced unit costs and high volumes by a longstanding incumbent in a particular market segment. This, however, restricts marketisation by reinforcing entry barriers.
Competition between unions whose membership has different skills and professionalization levels i... more Competition between unions whose membership has different skills and professionalization levels is a long-standing issue in the labour movement. This article investigates the conditions for why and how a unique cross-professional coalition of all Danish public-sector unions developed between 2017 and 2018. Operating in a favourable context, unions overcame professionalization differences when skilled brokers primed a common instrumental base as other unionists used a public interest frame to legitimate the coalition and its demands ideologically. However, once the common instrumental concern was met, the coalition collapsed. The article argues that union coalition-building depends on multiple factors comprising both contextual, and identity and relational conditions. The article further argues that adopting a framing that focuses on the public interest over professional self-interest helps to successfully overcome professional cleavages.
Drawing on comparative employment relations literature, this article explores how employment rela... more Drawing on comparative employment relations literature, this article explores how employment relations (ER) institutions support the ‘care coordinator’, a new role tasked with aiding the exchange of information between health and social services in the United States and the UK. Findings show that in both countries, multi-employer collective bargaining facilitated this role by providing good working conditions and a stable work environment; additionally, the new role performed better in England due to the broader scope of bargaining and supportive management practices. The article advances a comparative institutional perspective on the creation of new tasks focused on sub-national (sectoral and regional) ER.
The lack of an efficient support system for people with multiple, long-term health conditions has... more The lack of an efficient support system for people with multiple, long-term health conditions has increased costs, worsened health outcomes, and prompted policymakers to implement a boundary-spanning role within healthcare settings. While scholars have demonstrated the benefits of coordination roles and other such high-performance work practices (HPWPs) in this sector, the actual implementation of these practices is less clear. Based on a comparative case study approach, 153 interviews, and other qualitative data, this article explores frontline managers' HR philosophies and practices (‘frontline HRM relationality’) to explain possible variation in efforts to implement the boundary-spanning role of care coordinators (CCs). Despite strong policy support for the role, coordination has improved unevenly because of varying degrees of HRM relationality: findings show that higher frontline HRM relationality was associated with lower inter-occupational professionalization differences and higher boundary-spanning coordination. The article contributes to a nascent literature on HPWP implementation by theorizing frontline HRM relationality as a continuum that moderates professionalization-related coordination problems and highlights the importance of frontline HRM relationality for implementing HPWPs in professionalized settings.
The management of the professions has become increasingly challenging, reflecting the emergence o... more The management of the professions has become increasingly challenging, reflecting the emergence of new work roles in professionalized workplaces. Human Resource Management (HRM) scholars have, however, been slow to study the professions, particularly how the power they derive from ownership interacts with other forms of power. This article explores the use of different forms of power by a profession, general practitioners (GPs), in engaging with a new healthcare role, the physician associate (PA). Despite policy support for the role, we find GPs' employment of the role in primary care is low. This is explained by two GP responses to the introduction of the role: employment denial and subordination. We theorize these responses as deriving from GPs' ownership power, enhancing their managerial and knowledge-based control over PAs. In doing so, we open-up a research avenue in the study of workforce management focused on professions' ownership power.
Policymakers now have four decades' experience using marketization to address cost and quality pr... more Policymakers now have four decades' experience using marketization to address cost and quality problems in public-sector health services. While much is known about the challenges, it is difficult to draw lessons because there remains no agreed-upon definition of marketization. This article contributes a definition that focuses on the transaction, particularly the effects of funding arrangements on the intensity of competition among providers. Based on prior literature and 106 interviews with practitioners and researchers in five countries, the authors contribute a systematization of 12 concrete market mechanisms enacting three market principles. Furthermore, the authors analyze respondents' perceptions of healthcare marketization's effects on costs and quality. While marketization is a multifaceted, sometimes ambiguous phenomenon requiring further research before definite conclusions can be reached, most statements from our respondents about cost and quality effects were negative. Evidence for Practice • Examining health systems in five countries, we identify 12 different market mechanisms, i.e. concrete procedural changes that stimulate competition among service providers. • While these mechanisms sometimes enable improvements in cost and quality, our respondents identified many more examples of markets driving up costs and compromising quality. • A substantial number of respondents also stated that effects were unclear. • More research is needed to assess the effects of market mechanisms in healthcare, for which the article's conceptualization and findings can serve as a basis.
Part of an edited volume on mobilizations in hospitals called "Krankenhäuser in Bewegung. Interna... more Part of an edited volume on mobilizations in hospitals called "Krankenhäuser in Bewegung. Internationale Kämpfe für gute Versorgung und Arbeitsbedingungen"; edited by Julia Dück and Stefan Schoppengerd; published by the Rosa-Luxemburg-Stiftung, Berlin. The full, German language volume is available here: https://www.rosalux.de/publikation/id/43510/krankenhaeuser-in-bewegung-1?cHash=7d3c1d164e3e827f5f4b141e9c2e5128
Short Piece on COVID-19 in: In Critical Solidarity, Vol. 19, Issue 1. Newsletter of the American ... more Short Piece on COVID-19 in: In Critical Solidarity, Vol. 19, Issue 1. Newsletter of the American Sociological Association's Labor and Labor Movements Section. Available under: https://asalabormovements.weebly.com/newsletter.html
Governments world-wide have attempted to use market mechanisms and privatisation to increase the ... more Governments world-wide have attempted to use market mechanisms and privatisation to increase the quality and/or reduce the cost of healthcare. England's Health and Social Care Act 2012 is an attempt to promote privatisation through marketisation in the National Health Service (NHS). While the health policy literature tends to assume that privatisation follows from private-sector entry points, we argue that this is more likely if firms expect to make a profit. This paper examines the link between privatisation and marketisation in England drawing on 32 semi-structured interviews with private-sector and public-sector respondents, campaigners, and other experts conducted 6-10 months after the implementation of the 2012 Act. By generating a theoretical framework on the conditions of profitability we seek a better understanding of the conditions under which marketisation leads to privatisation. We find that significant barriers to profit-making remain after the reforms, including a top-down squeeze on prices, uncertainty in market rules, state dominance of funding and provision, and failures to depoliticise the market. These factors restrict private-sector involvement by frustrating profit-making. Where profits are made they are through reduced unit costs and high volumes by a longstanding incumbent in a particular market segment. This, however, restricts marketisation by reinforcing entry barriers.
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