Work environment, governance and service quality in Japanese healthcare
Objectives: This paper explores the contribution of governance to work environment and service quality in Japanese healthcare.
Research design: Data for this project was collected by giving questionnaires to the staff at eight cooperative hospitals across Japan in 2016 and compared with similar data from the staff at two public hospitals in Osaka in 2017. The staff sample from these 10 hospitals was a total of 6,859, with a response rate of 72.1%.
Findings: Based on the “demand, control, support” model of Karasek & Theorell, we found that more staff control over their daily work life resulted in greater staff satisfaction and promoted better service quality. Governance proved to be an intervening factor of significant importance and this paper considered three differentiated models for governing the provision of healthcare in Japan. They were distinguished in terms of the autonomy given to the staff in their everyday work life as well as patient inclusion in hospital discussions and decision-making.
Implications: Greater staff autonomy and more patient inclusion can have a positive effect both on work environment and service quality. Governance models can, therefore, contribute to or detract from goals of achieving greater staff autonomy, better service quality and more patient inclusion.
Contribution: This study tapped into Japan’s unique healthcare system, with two user-owned co-operative healthcare providers that manage nearly 200 hospitals with almost 50,000 beds, in order to explore work environment, governance and service quality. Questionnaires given to nearly 7,000 hospital employees allowed us to explore in depth the contribution of governance to work environment and service quality in Japanese healthcare. These results can serve as a best practice for other healthcare providers in Japan and elsewhere.
Birchall, J., & Sacchetti, S. (2017). The comparative advantages of single and multi-stakeholder co-operatives. Sterling, Scotland: ICA CCR Global Research Conference.
Cornforth, C. (2004). The governance of co-operatives and mutual associations: a paradox perspective; I, Annals of Public and Co-operative Economics, 75(1): 11–32.
Edelenbos, J. & v. Meerkerk, I. (2017). Introduction: three reflective perspectives on interactive governance. In: J. Edelenbos, I. van Meerkerk (Eds.), Critical reflections on interactive governance. Cheltenham, UK – Northampton, MA: Edward Elgar Publishing.
Hudson, B. (2014). Public and patient engagement in commissioning in the English NHS: an idea whose time has come?. Public Management Review, 17(1): 1–16.
Karasek, R., & Theorell, T. (1990). Healthy work: stress, productivity and the reconstruction of working life. New York: Basic Books.
Kurimoto, A. (2015). Social enterprise in Japan: the field of health and social services. ICSEM Working Paper, 7.
Kurimoto, A. (2018). Japan: health and elderly care cooperatives. In Co-operative health report: assessing the worldwide contribution of cooperatives to healthcare. International Health Cooperative Organisation, Eurisce.
Ostrom, E. (1993). A communitarian approach to local governance. National Civic Review, 82(3): 226–233.
Ostrom, E. (1996). Crossing the great divide, coproduction, synergies and development. World Development, 24(6): 1073–1087.
Osborne, S. P., Radnor, Z., & Nasi, G. (2013). A new theory for public sector management? Towards a (public) service dominant approach. American Review of Public Administration, 43(2): 135–158.
Pestoff, V. (1998). Beyond the market and state: social enterprise and civil democracy in a welfare society. Aldershot: Ashgate.
Pestoff, V. (2008). A democratic architecture for the welfare state. London & New York: Routledge. Pestoff, V. (2009). Towards a paradigm of democratic governance: citizen participation and co-production of personal social services in Sweden. Annals of Public and Cooperative Economy, 80(2): 197–224.
Pestoff, V. (2018). Work environment and service quality in Japanese healthcare. Paper presented to the International Conference on Social Economy in Asia, Osaka, Japan.
Pestoff, V., & Saito, Y. (2018). Work environment in Japanese health and elder care providers. Wageningen & Amsterdam, the Netherlands: conference paper presented at ICA & ISTR Conferences.
Peters, B. G. (1996). The future of governing: four emerging models. Lawrence, KS: University Press of Kansas.
Reuter, M., & Wijkström, F. (2018). Three parallel modes of governance in civil society: the steering and control of welfare provision in the Church of Sweden. Amsterdam: ISTR conference paper.
Sacchetti, S., & Catturani, I. (2017). The institutions of governance: a framework for analysis. Trento: Euricse Working Paper, 93/17.
Sacchetti, S., & Tortia, E. (2019, forthcoming). A needs theory of governance. Public Management Review.
Schmitter, Ph. (2002). Participation in governance arrangements. Is there any reason to expect it will achieve “sustainable and innovative policies in a multi-level context”? In J. R. Grote, B. Gbikpi (Eds.), Participatory governance: political and societal implications. Opladen: Leske + Budrich.
Sicilia, M., Guarini, E., Sancino, A., Andreani, M., & Ruffini, R. (2016). Public services management and co-production in multi-level governance settings.International Review of Administrative Sciences, 82(1): 8–27.
Spears, R. et al. (2014). Major perspectives on governance of social enterprise. In J. Defourny, L. Hulgård & V. Pestoff (Eds.). Social Enterprise and the Third Sector. London – New York: Routledge.
United Nations (1997). Co-operative enterprise in the health and social care sectors. New York: United Nations.
Vidal, I. (2013). Governance of social enterprises as producers of public services. In P. Valkama, S. Bailey & A.-V. Anttiroiko (Eds.), Organisational innovation in public services: forms and governance. New York – London: Palgrave.
Wikipedia, Spearman’s rank correlation coefficient, Rho, https://en.wikipedia.org/wiki/Spearman%27s_rank_correlation_coefficient (accessed on 1.6.2018).
World Health Organization (2005). Ninth Futures Forum on Health Systems Governance and Public Participation. Copenhagen: WHO.