Unions and Worker Voice as Vehicles for Healthcare Transformation in the U.S.
New research by authors at Cornell University’s Center for Applied Research on Work (CAROW) provides a systematic overview of the ways in which the US healthcare system lags other developed nations’ in terms of access, quality, and equity, despite outsized spending. In the paper “Unions and Worker Voice as Vehicles for Healthcare Transformation in the U.S.” Ariel Avgar and colleagues demonstrate how improving working conditions for healthcare workers can lead to improved healthcare outcomes for patients. The authors provide detailed recommendations tailored for philanthropic foundations, policymakers, unions, and community organizations to put their findings into action.
Key Takeaway:
The challenges facing the U.S. healthcare system are closely connected to healthcare workers and the conditions in which they are employed. Improving quality of care for patients, as well as efficiency and equity, requires changing the ways in which we employ, train, and treat the workforce that delivers this care. Unionization provides an effective pathway for promoting this change.
Why it matters:
This study shows the direct connection between job quality for frontline healthcare workers and the outcomes of the patients they care for. Even with the highest level of spending in the world, the US health system has resulted in poor health outcomes for its people, with significant disparities based on race and ethnicity. In this context, the evidence shows that unions don’t just present a means to address labor issues for frontline workers; they have the potential to transform the healthcare system and meaningfully address what ails it.
What the team did:
1) Documented the U.S. healthcare system’s performance for both patients and workers;
(2) Examined the U.S. healthcare labor-relations landscape and the strategic approaches unions use;
(3) Conducted a systematic literature review on union effects in healthcare;
(4) Analyzed original data on unionization and employment outcomes for nurses and direct care workers.
What they found:
• The U.S. spends more than peer nations yet fares worse on many key public health outcomes, with pronounced racial and ethnic inequities.
• Understaffing, burnout, job-related injuries, and unstable employment among healthcare workers all undermine quality, safety, and continuity of care for patients.
• Unions can give workers a voice and improve working conditions while at the same time improving patient safety and equity.
• Labor–management partnerships show some promise; investment in their capacity and governance is often key to their success.
• Policy and reform strategies are more likely to succeed when they link patient-centered goals with workforce-centered changes.
The study referenced in this explainer was supported by the Robert Wood Johnson Foundation.
