Leadership and Decision Making: Breaking Labor's Tradition to Win National Health Reform
The substantial increase in health care costs nationwide have forced unions to compromise higher wages for union members to keep health benefits secured in previous contract negotiations. Although union leaders have adopted plans to address systemic health care problems, little is known about the importance of union member input and transparency in these decisions. With union membership rates at their lowest in decades, and with union members facing negative public perception, transparency is essential for successful leadership, organizational morale, and union member loyalty. Although many aspects of union membership have been well documented, the literature about the decision-making processes of their leaders is lacking. The purpose of this case study was to examine the perceived experiences of labor leaders and key staff and to determine the main factors in their decision to support health care system reform. Kingdon's multiple policy stream theory and agenda setting theory, along with Simon's decision-making theory, provided the theoretical frame for this study. Data were collected through semistructured interviews of 13 labor leaders and key staff of 2 labor unions and 1 labor federation. The data were analyzed for consistent themes. Results demonstrated consistency in leadership structure, but decision-making processes were dissimilar. Input from members was a value with inconsistent significance, with results showing concerted efforts to involve members in one union and perceptions of actions directed by the president in another. Implications for positive social change include informing leaders of similar organizations of the importance of soliciting member input in their executive-level decision-making processes when making major changes to organizational practices.