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Collective Bargaining and Technological Investment: The Case of Nurses’ Unions and the Transition from Paper-Based to Electronic Health Records

dc.contributor.authorLitwin, Adam Seth
dc.description.abstractDoes the presence of a unionized nursing workforce retard U.S. hospitals’ transition from paper-based to electronic health records (EHRs)? After tying archival data on hospitals’ structural features and health information technology (IT) investment patterns to self-gathered data on unionism, I find that hospitals that bargain collectively with their registered nurses (RNs) appear to delay or forego the transition away from paper, consistent with existing theory and research in industrial relations and institutional economics. However, this relationship is fully mediated by a hospital’s payer mix: those serving a larger share of less lucrative, elderly, disabled, and indigent patients are more likely to adopt EHRs if they are unionized than if they are not, a result that holds even at the median payer mix. Indeed, this accords with research on the interplay of labour and technology as the aforementioned dynamics are driven entirely by RN-exclusive bargaining units for whom the new IT serves as a complement rather than as a substitute in production. Given the outsized role that unions play in the U.S. healthcare sector, the overall sluggish performance of the sector, and the expectations that policymakers have for EHRs, evidence that these unions are welfare-enhancing should be welcome news.
dc.description.legacydownloadsLitwin16_Collective_bargaining_and_technological_investment.pdf: 93 downloads, before Oct. 1, 2020.
dc.rightsRequired Publisher Statement: © Wiley. Final version published as: Litwin, A. S. (2017). Collective bargaining and technological investment: The case of nurses’ unions and the transition from paper-based to electronic health records. British Journal of Industrial Relations. Advanced online publication. doi:10.1111/bjir.12249 Reprinted with permission. All rights reserved.
dc.subjectnurses’ unions
dc.subjecthealth information technology (IT)
dc.subjecthealthcare workforce
dc.subjectelectronic health records (EHRs)
dc.subjectlabour relations
dc.subjectcollective bargaining
dc.subjectbargaining structures
dc.titleCollective Bargaining and Technological Investment: The Case of Nurses’ Unions and the Transition from Paper-Based to Electronic Health Records
local.authorAffiliationLitwin, Adam Seth: Cornell University


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