Path Dependency versus Social Unionism in Healthcare: Bringing Employers Back in

A central problem in contemporary employment relations is the fragmentation of work. This process is occurring in health systems as they decentralize services from hospitals to outpatient centers. While some unions have maintained inclusive employment systems, others have not. What explains this variation? The authors address this question through a matched case comparison of healthcare unions in Rochester and Buffalo, New York. The cities share many similarities, but in Buffalo unions have expanded their power, while in Rochester they have not. The authors show how path dependency from institutional legacies of employer power has shaped union capacity in the current period.