With around 1.2 million employees, the institutions of established churches, Caritas, and Diakonie represent a significant segment of the German employment system. These institutions are not subject to labor constitution law and co-determination laws, but rather to their own ecclesiastical regulations. Therefore, they are also a relevant subject of co-determination research, although they have rarely been the focus of studies until now. Jakobi fills this existing gap by systematically and comparatively presenting the co-determination policy of Caritas and Diakonie in the confessional hospital sector for the first time. He examines the actors and their relationships at both the national and regional levels, as well as exemplarily at four major hospital operators. This analysis is conducted at both the inter-company and regional levels.