With the rise of managed care, and the fall of Medicare/Medicaid payments, the US health care industry is consolidating. Hospitals are merging to achieve economies of scale; clinics and practices are coming together into networks. Hospitals are also reorganizing their workplaces, from top to bottom, in search of greater efficiency. An award was made to Eileen Applebaum of the Economic Policy Institute, Peter Berg of Michigan State University, Ann Frost of the University of Western Ontario and Gil Preuss of Case Western Reserve University to study these changes in the hospital workplace. The research team will focus upon low-skilled posts--hospital orderly, nurse assistant, dietician-- which are either being defined up, with higher skill requirements, or contracted out at lower wages. The researchers will interview managers and union officials, as well as surveying low-skilled workers, in twelve hospitals, eight in the United States, four in Canada, that are together broadly representative of the North American industry. Their study will document the forces remolding jobs and career paths in a key industry that currently employs one American worker in ten.