This chapter addresses a practical industrial relations problem, namely the absence of a monitoring framework to assess and improve labor management relations in organizations. The authors argue that assessing and improving organizational labor relations requires attention to both vertical and horizontal alignments of labor relations institutions and practices. Vertical alignment refers to the internal consistency across the strategic, functional, and workplace levels noted by Kochan, Katz, and McKersie in their strategic choice framework (1986). Drawing on two ‘‘best practice’’ labor relations cases, Saturn and Kaiser Permanente as well as two original case studies of healthcare organizations, the authors develop the notion of horizontal alignment, i.e., the internal consistency across labor relations processes, substantive issues, and outcomes.