Division of labor, or labor divided? Health care workers, health care work, and labor-management relations.

摘要

This dissertation is a case study of the changing nature of health care labor at Kaiser Permanente Northern California in the 1990s, focusing on the acute-care hospital and outpatient clinic in one city. This study explores the under-examined consequences of the 1990s transformation of the nation's health care by examining three major areas: (1) how health care delivery is constructed and restructured by a health care corporation, health care workers, and labor unions; (2) how this process is mediated by race, gender, and class; and (3) how the workers assigned to the most physically and mentally taxing work of health care experience and interpret the changes. The study also explores how the changes in labor process inform inter-group relations and stratification of the Kaiser non-physician health care workforce.;This study builds on feminist theories that examine the intersectionality of race, gender, class, and other markers of social position, in order to examine the structures and processes that reproduce inequality and oppression. Workers' experiences are central to this analysis, and are the site in which we can theorize how intersecting inequalities are reproduced, structuring exploitative relations in health care and perpetuating divisions within the workforce.;In-depth interviews were conducted with three union officials and 23 health care workers, drawn from the workforce historically assigned to the caregiving and dirty work—a predominantly female workforce stratified by race-ethnicity, class, and occupation. Interview transcripts were systematically coded for prominent themes and social processes. Interview data were also analyzed within a historical narrative of Kaiser's labor relations, and demographic trends of health care workforce composition.;The data suggest that Kaiser's restructuring entrenches exploitation of and divisions within a workforce organized by intersecting inequalities of race, gender, and class. Based on workers' accounts, Kaiser's restructuring exploited the workforce and degraded the quality of patient care through reorganizing and intensifying the health care labor process. Despite workers' shared concerns, solidarity was consistently undermined by a confluence of historical and locally-specific factors, which reproduced racialized and gendered structures and processes of exploitation, stratification and conflict among the Kaiser workforce.