The State, Power Hubs, and Changes in the Organization of Work: The Case of Care Coordination in the Bronx

In Market Sociology and Institutional Theory, the state has been examined as an important factor that shapes how markets work and determines who is empowered by the market. However, organizational dynamics tend to feature less in these literatures. By contrast, Workplace Studies and the Organizational Behavior literature have examined intra- and inter-organizational factors as important, yet separate determinants of the organization of work. In this paper, I bring these literatures together by examining how the state mediates the relationship between intra- and inter-organizational factors as a determinant of the organization of work.

I examine these relationships through in-depth, qualitative case studies of four healthcare organizations working in the Bronx, New York City, an area with an above-average low-income, high-risk patient population, in the context of a state-wide health program to increase the coordination of care. I expect to find that the degree of an organization’s institutionalization as well as how the state empowers specific market actors creates hubs in the market that centralize power and inhibit changes in the organization of work. More specifically, I examine how management hierarchies, trade unions, traditional professions, and hospitals centralize power in the market.