SUPPORTING THE EMERGENCE OF AN OCCUPATION THROUGH ENABLING INSTITUTIONAL WORK: A COMPARISON OF THE CARE COORDINATOR OCCUPATION IN NEW YORK CITY AND LONDON

Abstract

How do frontline management practices, regulators’ policy frameworks, and subnational institutions influence the breadth of an emerging occupation’s jurisdiction? This dissertation employs a qualitative, multi-level matched case comparative study of the emergence of the care coordinator (CC) occupation in low-income communities in New York City and London to answer this question. Based on 285 semi-structured interviews, 84 hours of non-participant observation, 150 core documents, and focus groups, the dissertation examines CCs’ breadth of jurisdiction in and across 15 workplace cases and employs the matching of cases to explain this variation.The dissertation’s main finding is that, depending on their manifestation as either ‘supportive’ or ‘unsupportive’, the interaction of four main factors influences the breadth of an emerging occupation’s jurisdiction. More specifically, regarding frontline management practices, these were ‘supportive’ if they defined jobs as high-skill and with low workloads; if they defined CCs’ work as complementary to other occupations’ work; and if they provided normative support, and discretion for time-consuming tasks. These practices provided CCs with the skills, time, receptiveness of other occupations, and ability to engage in value-adding tasks necessary to broaden their jurisdiction. Policy program frameworks could also broaden jurisdictions by constraining management practices to be supportive. They did so by mandating or recommending high standards and enforcing these through financial incentives and the monitoring of managers’ compliance. Finally, employment relations and health and care actors could broadly support CCs’ jurisdiction directly by stabilizing their work environments and providing mechanisms of integration; and indirectly, by promoting supportive management practices. The dissertation’s theoretical contribution consists of a conceptualization of two ideal types. In the ‘enabling’ type of accumulation of institutional work, the four main factors manifest as supportive, thereby facilitating a broad jurisdiction. In the ‘inhibitive’ type, the factors manifest as unsupportive, thereby facilitating a narrow jurisdiction. A mix of unsupportive and supportive manifestations constituted moderately broad jurisdictions. Based on the findings and this conceptualization, the dissertation argues that collective actors’ effort to institutionalize an emerging occupation can create a substantial deviation from liberal market economies’ unsupportive national political economy structures at regional and sectoral levels.