Institutional support for new work roles: The case of care coordinators in the United States and England
| Published date | 01 December 2023 |
| Author | Nick Krachler |
| Date | 01 December 2023 |
| DOI | http://doi.org/10.1111/bjir.12748 |
Received: 27 July 2022 Accepted: 21 April 2023
DOI: 10.1111/bj ir.12748
ORIGINAL ARTICLE
Institutional support for new work roles: The
case of care coordinators in the United States
and England
Nick Krachler
King’s Business School, King’sCollege
London, London, UK
Correspondence
Nick Krachler,King’s Business School,
King’s College London, Bush House, 30
Aldwych, London WC2B 4BG, UK.
Email: nick.krachler@kcl.ac.uk
Funding information
Cornell Engaged Initiative
Abstract
Drawing on comparative employment relations litera-
ture, 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 bargain-
ing 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.
In the healthcare sector, new roles have been created in abundance. Particularly in response to
increasing patient demand and staffing shortages, managers and policymakers have introduced
new, often lower-skilled roles likenursing, medical or general healthcare assistants in the United
States and the UK (Bach et al., 2008; Weinberg, 2003) with the aim of freeing up high-skilled
roles like nurses or physicians from performing lower-status tasks (Kessler et al., 2013). Similarly,
recent policies intended to align different health and social services to improve workforceproduc-
tivity and health outcomes have led to new coordination roles. Instead of assuming existing tasks,
these coordinators are given new tasks like exchanginginformation with other care providers like
mental health professionals or social workers, or even welfare and government agencies, to assist
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and
reproduction in any medium, providedthe original work is properly cited.
© 2023 The Authors. British Journal of Industrial Relationspublished by John Wiley & Sons Ltd.
Br J Ind Relat. 2023;61:951–974. wileyonlinelibrary.com/journal/bjir 951
952 BRITISH JOURNAL OF INDUSTRIAL RELATIONS
people in managing the physical, mental and social aspects of their long-term conditions (Jackson
et al., 2013; Simms, 2016).
For these new rolesto collaborate effectively within the established system of occupations, how-
ever, severalpotentially detrimental employment relations (ER) issues need to be mitigated. New
roles could generate conflict if perceived as a threat to the status of existing roles or as making
their work more difficult. The former problem could derive from a lack of clarity around the new
roles, which could engender a lack of trust or the fear of being substituted (Kessler et al., 2015),
while the latter might be rooted in the inherently stressful, time-strapped nature of healthcare
work (Bach & Kessler, 2012;Givan,2016). For workers performing these new roles, in turn, an
inability to perform their tasks could mean they potentially reduce the scope of their work or fail
to achieve their main aims, leading to the role’s discontinuation.
Despite these important ER implications, extant studies on new roles have not considered ER
institutions, such as collective bargaining structures as potential solutions to these problems,
focusing instead predominantly on frontline, managerial solutions (Kessler et al., 2013). Fur-
thermore, while it is a common finding that collective bargaining improves working conditions
(Doellgast, 2012) and leads to other positive outcomes (Doucouliagos et al., 2017), the compar-
ative employment relations (CER) literature has neglected to apply such insights to the study
of workforce transformation through the creation of new roles. Moreover, the CER literature has
often assumed consistency between national ‘liberal market economy’ (LME) institutions (Givan,
2016; McLaughlin & Wright, 2018) to the neglect of studying potential sub-national (sectoral and
regional) variation between LMEs (Crouch et al., 2009). To contribute to and advance these lit-
eratures, this article examines whether and how ER institutions influence how well a new role
achieves its aims.
Based on comparisons of 15 workplace cases of the ‘care coordinator’ (CC) role complemented
by regional and sector-level interviews in the United States and England, and drawing on 258
semi-structured interviews, this article argues that supportive ER institutions positively influ-
ence new roles’ task performance, with a broader scope of bargaining and more supportive
management practices achieving better task performance. Despite both countries being LMEs,
multi-employer collective bargaining structures in each provided good working conditions and
a stable environment, facilitating task performance. Moreover, the CC role performed better
in England. This occurred because the English agreement was broader in scope, covering the
entire national healthcare sector instead of just one region, including spilling over into the non-
union sector; additionally, it positively interacted with better management practices, such as
higher skills requirements for CCs, lower CC workloads and more professionalized frontline
management.
The article thereby makes two contributions to the field: first, it advances a comparative insti-
tutional perspective in the study of new work roles, extending the study of collective bargaining to
cover new roles’ task performance; second, it strengthens a perspective in CER that emphasizes
the importance of sub-national (sectoral and regional) institutions over national LME institutions
and that seeks to broaden a sole focus on managerial factors. Therefore, in this perspective, effec-
tive workforce transformation through new rolesdoes not derive from management unilateralism
but from the institutional embedding of management practices (Godard, 2004) in multi-employer
collective bargaining structures at sub-national level, even in LME contexts.
After developing two conflicting perspectives on the interaction between managerial and
institutional factors as a new role takes shape, we describe our methodology. We then present
the comparative findings and subsequently conclude with our article’s theoretical and policy
implications.
To continue reading
Request your trial