Research Aimed at Improving Health Care

Research by an ILR graduate student shows how trade unions can improve medical and social services. An agency in New York City has incorporated some of his findings to help improve health care delivery.
Nick Krachler research on improved health care.
Monday, October 29, 2018

Nikolaus Krachler MS/Ph.D. ’20 knows what it’s like to be a health care worker with ideas for improving patient care, but with no one willing to listen.

“When I was a paramedic in Austria, I observed how hospitals and medical practices worked and how their policies affected patients with chronic conditions,” said Krachler, a doctoral candidate based in ILR’s Department of International and Comparative Labor.

“I also noticed there were big differences in status among health care workers, and being paramedics, we were looked at as pretty low in the health care system’s status hierarchy. That showed me that status differences between occupations are an important dimension in understanding how health care works.”

That experience planted the seed for Krachler’s research into improving care coordination programs that track medical and social services care for people with chronic conditions in the United States and United Kingdom – and how health care workers can play a critical role in breaking down communication barriers facing those patients.

“A lot of problems have to do with navigating complex health care systems and information being lost or poorly coordinated, which can lead to really bad health outcomes,” he said.

Krachler, awarded an Engaged Cornell student grant for his research, is evaluating how public policymakers and researchers have planned and operated programs – usually without workers’ input.

“The planners often underestimate how trade unions and power dynamics between care providers contribute to programs’ success or failure,” he said. “The best way to improve coordination is to strengthen the role of the workers through trade unions and the amplification of workers’ knowledge, as well as by regulating and funding health services adequately.”

Krachler interviewed more than 200 people in the two countries, held focus groups and spent almost 80 hours observing practices. More research is slated.

The work is already having an impact, according to Mary Morris, director of workforce innovation for Bronx Partners for Healthy Communities.

“Nick’s meetings with our care coordination staff served not only to evaluate our training program, but to add the voice of front line staff to the complex changes we are striving to make to health care delivery in the poorest congressional district in the nation. We are most grateful for his work.”

Krachler thinks his research will conclude that, when it comes to better care coordination, trade unions make a positive impact by reducing turnover, improving working conditions and reducing workloads. An experienced, educated and credentialed workforce improves coordination, he said.

Krachler hopes to see more integrated and government-driven systems that will support training, reduce competition, incorporate trade union and professional association decision-making processes, and regulate emerging occupations.  

Recalling his years as a paramedic, Krachler hopes his research will convince policymakers of the importance of working with trade unions, and educating – and listening to – workers. “My goal is to understand and highlight best practices in care coordination programs that show how to improve the cost and quality of care while being sustainable for the workers.”

Phil Thompson, regional organizer of UNISON, the United Kingdom’s largest union, said he is eager to see Krachler’s research. 

“Health care across the globe is facing many challenges, and no nation has found a way to the kind of society assured of good incomes, sound housing and clean water for all its citizens ... I, for one, am looking forward to seeing the fruits of Nick’s work.”

Learn more about ILR research.