The paper investigates the labor process at a private, nonprofit hospital, Children's Charity Hospital of Hudson, between 1947 and 1978. The author explains changes in the labor system that hospital management made, such as adding to the number and variety of intermediate outputs, increasing mechanization, stratifying and specializing skills and authority, and replacing an informal, personalized organization by bureaucratic structures. The author contends that management's choise of labor process characteristics depended not only on market and technical constraints but also on management's desire to maintain and increase worker's pace and accuracy and to secure its authority over their production activities. Put another way, considerations of power and of potential for conflict, not just of technically "optimal" input combinations, determined the characteristics of the hospital labor process.