Unicom building
Room: 7.4500
Mary-Somerville-Straße 7
28359 Bremen
1 p.m. - 3 p.m.
Sonderforschungsbereich 1342 "Globale Entwicklungsdynamiken von Sozialpolitik", Universität Bremen
Lecture Series
CRC colloquium

In the last 25 years, hospital services in East-Central Europe (ECE) have been undergoing profound transformation as a result of the parallel processes of post-communist transition, globalisation and Europeanisation. In this context, the hospital sector in ECE has been affected by privatisation and liberalisation, which has resulted in an emergence of public-private constellations of financing, provision and governance, and has significantly influenced sectoral labour relations and employment conditions (Kaminska and Kahancova 2017). In addition to these processes, with their entry into the European Union, ECE countries have been facing the task of implementing EU regulation in the sector, among others the Working Time Directive (WTD).

Drawing on the work on institutional change by Streeck and Thelen (2005) and Mahoney and Thelen (2010) our study analyses the policy-making processes related to compliance with WTD in the hospital sector in ECE. In particular, the paper points to the importance of the availability of resources whereby ‘struggles over the meaning, application, and enforcement of institutional rules are inextricably intertwined with the resource allocations they entail’ (Mahoney and Thelen 2010:11). Given the scarcity of financial and human resources, especially doctors and nurses, and faced with a potential collapse of the hospital sector should the WTD be duly implemented, the state in ECE countries has often reacted to the regulatory challenge of WTD implementation by decoupling formal and behavioural compliance (Zhelyazkova et al. 2016; Börzel et al. 2017).

While WTD has been correctly transposed into national law across the region, in a number of countries the practices of intentional non-application on the ground have ranged from lack of effective monitoring of implementation, through tacit acceptance of non-compliance to active circumvention, pointing to the existence of a ‘world of dead letters’ (Falkner et al. 2008). Thus, rather than adjusting the level of financial and human resources in the hospital sector to the EU social policy requirements, the state in ECE has opted for policy drift (see Hacker 2010; Streeck and Thelen 2010) which has led to a deterioration of employment and working conditions and demise of sectoral labour relations. The paper relies on qualitative methods and comparatively analyses case studies of four ECE countries (Czech Republic, Hungary, Latvia and Poland).