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

Uddin, Shahzad; Mori, Yuji; Shahadat, Khandakar

Abstract

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.

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, Article 112719. https://doi.org/10.1016/j.socscimed.2019.112719

• Journal Article Type: Article
• Acceptance Date: Dec 2, 2019
• Online Publication Date: Dec 3, 2019
• Publication Date: Jan 2, 2020
• Deposit Date: Jan 16, 2020
• Publicly Available Date: Dec 4, 2022
• Journal: Social Science & Medicine
• Print ISSN: 0277-9536
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 245
• Article Number: 112719
• DOI: https://doi.org/10.1016/j.socscimed.2019.112719
• Keywords: Japan; Governance; Healthcare; NPM; Medical profession; Culture; Institutions and accountability
• Public URL: https://hull-repository.worktribe.com/output/3363659