Healthcare worker cooperatives: organizational variation and institutional constraints

This article examines nine U.S. healthcare businesses organized as worker cooperatives, analyzing variation in their ownership, governance, and organizational structures. Drawing on qualitative interview data from cooperatives operating in-home care, physical therapy, mental health, holistic health, and hospital support services, the study analyzes governance systems, membership criteria, compensation, and profit-sharing arrangements, managerial structures, and formal mechanisms for worker participation in decision-making. The purpose of the article is to assess how cooperative worker ownership operates within the institutional and market constraints of the U.S. healthcare sector, and to begin to identify the conditions under which such enterprises may achieve stability. Across cases, worker cooperatives introduce formalized channels for worker participation in domains that, in conventional healthcare firms, are typically reserved for management. At the same time, the cases reveal substantial organizational heterogeneity. A small number of cooperatives achieved scale, financial stability, and relatively robust benefit provision, while others remained small and operated with limited margins. Governance models ranged from hybrid forms combining democratic ownership with conventional managerial hierarchies to more collective nonhierarchical approaches to coordination and decision-making. All cooperatives benefited from ecosystem supports. All operated within institutional and competitive environments that affected growth.