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Labor process research has documented a shift in the nature of control – from techniques that aim to limit worker discretion to consent-oriented controls that are believed to generate greater effort by increasing intrinsic rewards or bonding employees to managers and/or the firm. Over the past several decades, however, growing pressure to increase profits has prompted firms to adopt cost-cutting strategies that have eroded job security, relationships with management and commitment to organizational goals. This study investigates how a changing labor process and rising job insecurity shape workers’ orientations toward work, managers and the firm, and in turn influence workplace behavior. Analyses of content-coded data on 212 work groups confirms that discretion-limiting controls (supervision, technology and rules) are associated with more negative orientations and/or reductions in effort (with variations across distinct forms of control), while investment in workers’ human capital (but not involvement of workers in decision-making) has the reverse effect – ­generating more positive orientations toward work, managers and the firm, and (in turn) promoting discretionary work effort and limiting covert effort restriction. Implications of insecurity are more complex. Both layoffs and temporary employment reduce commitment to the organization, but layoffs generate conflict with management without reducing effort, whereas temporary employment limits effort without producing conflict. We illuminate underlying processes with evidence from the qualitative case studies.

This article examines how a profit-centered restructuring of labor relations in an academic medical center undermined team-based care practices in its intensive care unit. The Institute of Medicine has promoted team-based care to improve patient outcomes, and the staff in the intensive care unit researched for this paper had established a set of practices they defined as teamwork. After hospital executives rolled out a public relations campaign to promote its culture of teamwork, they restructured its workforce to enhance numerical and functional flexibility in three key ways: implementing a “service line” managerial structure; cutting a range of staff positions while combining others; and doubling the capacity of its profitable and highly regarded intensive care unit. Hospital executives said the restructuring was necessitated by changes to payment models brought forth by the Affordable Care Act. Based on 300 hours of participant-observation and 35 interviews with hospital staff, findings show that the restructuring lowered staff resources and intensified work, which limited their ability to practice care they defined as teamwork and undermined the unit’s collective identity as a team. Findings also show how staff members used teamwork as a sensitizing concept to make sense of what they did at work. The meanings attached to teamwork were anchored to positions in the hospitals’ organizational hierarchy. This paper advances our understanding of he flexible work arrangements in the health care industry and their effects on workers.