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Paper short abstract

We explore how outsourcing and informal delegation shape care and maintenance work in hospitals. Based on ethnography in Swiss and Austrian hospitals, we examine how value is negotiated across formal hierarchies, migration trajectories, and labor fragmentation.

Paper long abstract

This paper draws on ethnographic research from the Global Hospital project to examine outsourcing and delegation as de/valuation processes that shape everyday hospital work. In Swiss and Austrian hospitals, cleaning and catering are often outsourced, while nursing care is increasingly performed by internationally recruited staff. These “intermediarisation” processes fragment labor and reinforce hierarchies over what is valued as “skilled” and “core” work.

We explore both formal outsourcing, such as maintenance subcontracting, and informal delegation, such as nurses asking cleaners or aides to assist with care tasks when time is scarce. These practices reveal how responsibilities blur in everyday routines, with significant implications for how hospital work is defined and de/valued.

Care and maintenance workers, mostly women and/or migrants, are disproportionately affected by in/formal outsourcing. Understaffing, substandard pay, and casual contracts lead to overwork and precarious labor market integration. Care and maintenance workers are inter/mediated through recruiting, outsourcing, and delegation on the one hand and entangled through cooperation, conflict, and more-than-medical ways of doing healthcare together on the other. We explore how workers themselves navigate these dynamics.

By linking outsourcing with informal delegation and international recruitment and by looking across professional boundaries, we discuss “outsourcing” in hospital spaces as multifaceted and entangled with other, more informal forms of delegation and international recruitment practices. We approach outsourcing not just as a managerial strategy, but a lived process of de/valuation shaped by relational work and embodied expertise, examining the frictions, dependencies, and tensions that arise when labor is fragmented.