Details
Year: 2019
Published in: EMES Selected Conference Papers
Cited as: Pestof, V., (2019). Work environment, governance and service quality in Japanese healthcare. EMES Selected Conference Papers.
Subject
Work environment, governance and service quality in Japanese healthcare
Abstract
This paper explores the contribution of governance to the work environment and service quality of Japanese healthcare. Japan has a unique healthcare system with two user-owned cooperative healthcare providers. Together the Koseiren of Japanese Agriculture and the Health and Welfare Co-op Federation of the Japanese Consumer Co-op Union manage nearly 200 hospitals with almost 50,000 beds, which is more than the total number of hospital beds in Sweden and Denmark combined. Data for this project was collected by 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 the 10 hospitals reaches a total of 6,859, for a response rate of 72.1%. Based on the Karasek & Theorell ‘demand, control, support’ model we expect that more staff control over their daily work-life will promote greater work satisfaction and more satisfied staff, in turn, will provide better quality services than dissatisfied staff. Moreover, inclusive governance models not only allow the staff more autonomy in resolving everyday work-life issues and problems, they can also promote a multistakeholder dialogue that facilitates greater patient participation in their own healthcare and contributes to better service quality. Governance proves to be an intervening factor of significant importance and this paper considers three differentiated models for governing the provision of healthcare in Japan: a democratic, multi-stakeholder model; a stewardship model and a more traditional command and control model. These models can be 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. The participatory form of democracy and collective action found in social enterprises providing healthcare can serve as a ‘best practice’ for other public and private providers in Japan and elsewhere.
