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

Uddin, Shahzad and Mori, Yuji and Shahadat, Khandakar (2020) 'Private management and governance styles in a Japanese public hospital: A story of west meets east.' Social Science and Medicine, 245. ISSN 0277-9536

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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.

Item Type: Article
Uncontrolled Keywords: Japan, Governance, Healthcare, NPM, Medical profession, Culture, Institutions and accountability
Divisions: Faculty of Social Sciences > Essex Business School
Faculty of Social Sciences > Essex Business School > Essex Accounting Centre
Depositing User: Elements
Date Deposited: 12 Mar 2020 10:03
Last Modified: 12 Mar 2020 10:03
URI: http://repository.essex.ac.uk/id/eprint/26640

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