Saturday, April 16, 2016
Ormandy East (DoubleTree by Hilton Philadelphia Center City)
In the public and private health care sectors there has been a cascade of reform initiatives across the industrialized world over the past two decades. Key stakeholders have prioritized the goals of saving money, expanding access and improving quality to differing degrees in different contexts. The frontline providers in health care – including professionals as well as much lower paid workers – have been heavily involved in these changes. This paper analyzes the role of frontline health care workers both acting and reacting in the restructuring of the health care sector. Covering both workers with well-developed professional identities (and associations) and those less often represented by unions, the paper expands Paul Pierson’s argument that “policy creates politics” to show that past welfare state policies have created interest groups of welfare state providers. When organized, these interest groups can both enable and constrain the possibilities for change, both at the point of policy creation and the point of implementation. The paper further argues that bottom-up change initiated by front-line workers stands a higher likelihood of success than top-down change promulgated by politicians and bureaucrats, especially when the worker-led change involves broad inter-professional employee engagement, and improves the health care delivery system for both patients and providers. Using cases form the American and British health care systems, the paper shows that frontline workers play a crucial role in determining the outcome of any attempt at reform or restructuring in health care.
