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.


work environment; demand & control; governance; service quality; healthcare; co-operatives; social enterprises

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Published : 2019-06-27

Pestoff, V. A. (2019). Work environment, governance and service quality in Japanese healthcare. Journal of Public Governance, (47(1), 5-17.

Victor A. Pestoff 
Ersta Sköndal Bräcke University College  Sweden


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