In 1988, the Brazilian Federal Constitution was implemented, systematizing the hierarchical structure of union representation in Brazil, simultaneously enshrining the principles of unity and non-interference and intervention by the State in the organization of unions.

In this context, the Union of Charitable Hospitals and Hospitals of the State of São Paulo (SINDHOSFIL/SP) was founded, representing exclusively the interests of charitable hospitals and hospitals in the state of São Paulo.

The creation of this entity marked the beginning of independent labor legal representation for nonprofit healthcare institutions. However, the union faced some challenges in its early days, as it engaged in a lengthy dispute with the employers' union of healthcare establishments, the entity to which all healthcare establishments in the state of São Paulo, whether philanthropic or not, were affiliated.