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Workenvironment,governanceandservicequalityinJapanesehealthcare
qualityarecloselyrelatedorlinkedtoeachother.
Anemployeewhohastossedandturnedallnight
worryingaboutworkrelatedproblems,who
feelstiredandexhaustedwhenhe/shewakes
inthemorning,whodreadstheideaofgoingtowork
becausehe/shehaslittleornocontrolorinfluence
onthewhat,when,why,whereandhowofhis/her
dailyroutines,whohaslittlechancetolearnnew
thingsoradvanceatwork,suchanemployeewill
notprovideasgoodqualityserviceasonewhohas
theoppositeexperienceandfeelingabouthis/her
work.Likewise,aclientwhoexperiencesanunhappy,
stressedordisgruntledserviceprofessionalwillnot
experienceasgoodservicequalityasonebeing
servedbyanemployeewiththeoppositefeelings.
Wehopetoshedmorelightontheimportance
ofsuchmechanismsfortherelationshipbetween
thestaffandtheirclientsandonhowthisisreflected
inservicequalityinhealthcare.
Theoptimalsettingforexploringgreater
citizenparticipationinhealthcarewouldbefound
inuser-ownedandcontrolledhealthcareservices.
Unfortunately,thereareveryfewexamplesof
suchservicesinEurope;however,Japanhas
auniquehealthcaresystemwithnotjustone,but
twouser-ownedhealthcareproviders(United
Nations,1997).Theyare:theAgriculturalCo-ops
(JapanAgriculture,JA),oritshealthandsocial
serviceaffiliate,Koseiren,whichmainlyprovides
healthcareinruralareas;andtheMedicalCo-ops,
whichmostlyprovideshealthcareinmajorurban
areas.Koseirenprovideshealthcareservicesfor
itsmembersandthepublicat114hospitalsand
66clinicsnationwide,withacapacityofnearly
35,000beds.Almost40%oftheirhospitalsare
locatedinmunicipalitieswithpopulationsofless
than50,000people(Kurimoto,2015and2018).
In2010theJapaneseHealthandWelfareCo-
opFederation(HeWCO-OP)broughttogether
themedicalco-opsassociatedwiththeJapanese
Consumers’Co-operativeUnion(JCCU).Today
itruns75hospitalswithmorethan12,000beds
nationwide.TheMedicalCo-opsalsooperate
267clinics,70dentalclinicsand187visiting
nursestationsnationwide.
Comparingthesetwouser-ownedhealthcare
groupswithpublicprovidersofhealthcareinJapan,
enablesustoidentifyandisolatethefactorsthat
facilitategreaterstaffcontrolovertheirwork
lifeandactivepatientparticipationintheirown
healthcare.ThisresearchprojectonCo-production,
WorkEnvironmentandServiceQualityinJapanese
Healthcarereliesonseveraldatasources.Firstisan
organisationstudythatiscomprisedofinterviews
conductedinMay2013withtheCEOsandboard
membersoftheeightco-operativehospitals
thatagreedtotakepartinourstudy.Secondis
astaffstudybasedonquestionnairesdeveloped
toexploretherelationshipbetweenworklifeand
servicequalityattheseeightco-operativehospitals
in2016andthestaffoftwopublichospitalsinOsaka
in2017.Inallwereceived6,859staffresponses
fromthese10hospitals,witharesponserate
of72.1%.Thirdisthedatacollectedbyapatient
studyandvolunteerstudyin2017,alsothrough
questionnaires,atfouroftheco-operativehospitals
includedintheorganizationstudyandstaffstudy.
Thepatientstudyincludes631respondentsand
thevolunteerstudyresultedin236completed
volunteerquestionnairesbeinggatheredatthefour
co-operativehealthcareproviders.1
Previousresearchonworkenvironment
Thisprojectproposestoexploretheinterplay
betweenfourmetavariablesintheprovision
ofJapanesehealthcare:workenvironment;service
1ThedatacollectionwasfinancedbytheJapanese
SocietyforthePromotionofScience(JSPS)andthe
MitsubishiFoundation,anditwassupervisedbyProf.Yayoi
Saito,OsakaUniversityandtheConsumerCo-operative
InstituteofJapan(CCIJ).Theprojectisconductedwithin
theframeworkofanestablishedco-operationbetween
seniorresearchersatErstaSköndalBräckeUniversity
CollegeinStockholm(Prof.V
.Pestoff&DrJ.Vamstad)
andtheFacultyofHumanSciences,OsakaUniversity
(Prof.Y
.Saito).ThisinterdisciplinarygroupofSwedish
andJapaneseresearchersissupportedbyareference
groupoftherelevantcooperativehealthcareproviders
inJapan,KoseirenandtheJapaneseHealthandWelfare
Co-operativeFederationHeWCO-OPJAPAN.
ZarządzaniePubliczne/PublicGovernance1(47)/2019
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