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Private management and governance styles in a Japanese public hospital: A story of west meets east

Uddin, Shahzad; Mori, Yuji; Shahadat, Khandakar


Shahzad Uddin

Yuji Mori


This paper examines a case of healthcare governance reform in a Japanese hospital to demonstrate how and why physicians may resist NPM ideals in healthcare. We find that the governance reform departed significantly from its idealized form. The intended structure of decentralized governance was ruptured by the CEO, with unanticipated consequences. The power of the medical school, arising out of the ikyoku system in the context of chronic shortages of physicians and the respect afforded to physicians by wider society, was played out in the hospital, with cost management taking a back seat. We find that the general patterns of interaction between and among key stakeholders in relation to accountability and the governance process are shaped by some form of verticality, monologues rather than dialogues, indirectness and silence rooted in Japanese cultural context. Cultural political economy approach guided us to examine both semiotic and extra semiotic features and their dialectical moments with key actors in assessing the limits of NPMs in non-Western contexts.

Journal Article Type Article
Publication Date Jan 2, 2020
Journal Social Science & Medicine
Print ISSN 0277-9536
Electronic ISSN 0277-9536
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 245
Article Number 112719
APA6 Citation Uddin, S., Mori, Y., & Shahadat, K. (2020). Private management and governance styles in a Japanese public hospital: A story of west meets east. Social science & medicine, 245,
Keywords Japan; Governance; Healthcare; NPM; Medical profession; Culture; Institutions and accountability

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