Respondents and response rate for staff at the hospitals in this study, 2016 and 2017. .... The proportion of full-time permanent staff is more than three fourths at ... the staff at Koseiren hospitals work 40 plus hours per week, while less than half ... Less than half of them work 40 hours per week, but many more claim that they.
1
Staff survey: a preliminary overview of the results from 10 hospitals. By Victor Pestoff The following tables and comments provide the preliminary results of the Staff Survey at eight cooperative health and eldercare providers in August and September of 2016 and later at two public hospitals in Osaka in 2017. The response rate for the staff at these ten hospitals is found in Table 0 below. There were four cooperative hospitals from the Health & Welfare Co-op Federation of Japan (HeW CO-OP), affiliated with the Japanese Consumer Co-operative Union (JCCU), and four cooperative hospitals from the social welfare branch of Japanese Agriculture (JA). In this report the former hospitals will be indicated as Medical Co-ops, while the latter will be found under the heading Koseiren. Table 0. Respondents and response rate for staff at the hospitals in this study, 2016 and 2017. Hospital*
No. sent
No. returned
Response rate
% per hosp. gp.*
2,852
Medical Co-ops: Saitama
2,000
735
36.7%
26.0
Minami
1,250
988
79.0%
35.0
Himeji
860
714
83.0%
25.3
Kirari
430
415
96.5%
14.7
1,356
90.4%
52.9
2,562
Koseiren: Toyota
1,500
Saku
790
595
76.3%
23.2
Bange
390
334
85.6%
13.0
Asuke
310
277
89.4%
15.8
418
59.7%
28.9 71.1
1,445
Public: Minno City
700
Toyonaka City
1,280
1,027
80.2%
Total (co-op + pub.)
9,510
6,859
72.1%
*adds column wise.
Questionnaires were sent directly to the participating hospitals and they were collected and returned to Osaka University by the hospitals. This insured a very high response rate in most cases; however, the Saitama Health Cooperative north of Tokyo asked its staff to respond by e-mail, resulting in a much lower response rate. In general, the response rate was rather high, 72.1%, but it varied from 59.7% to 96.5%, with the exception of Saitama. The tables included in this overview are based on SPSS data runs, prepared in Sept. 2017 and revised in May 2018, with the addition of the new data from public hospitals. It was lightly edited in January 2019. Many of the questions included in this study were five scale agreement issues, ranging from ‘agree’ to ‘disagree’, with the alternatives ‘agree somewhat’, ‘neither agree or disagree’ and ‘disagree somewhat’ in between. Questions 19, 28 and 33 provide respondents with room for comments, but only the first one is
2 included here. The latter two hopefully will be made available later. The figures included in this preliminary overview are calculated on the basis of the proportion of positive answers (agree and agree somewhat) provided by the respondents to our questions. The average for the four Medical Co-ops, the four Koseiren, and two public hospitals provides the base for most of the tables and comments in this preliminary overview. The difference between the highest and lowest is indicated in a separate column, Dif. (h-l). In general, the Medical Co-ops score highest on most items found in the Staff Study. However, when either the Koseiren or public hospital staff rates highest, this will be indicated by a K or P after the difference score between hospitals. See Table 1 below as an illustration of this notation. Differences of less than 5 percentage points are considered small, moderate between 5 and 10 percentage points, and large when they are 10 percentage points or above. Comments will normally only be made when differences between these hospital groups are 10% or more. In addition, a dozen or more additive indices were calculated for several questions in this study, mainly about work environment (Qs 9 – 18). An index allows us to summarize the general tendency found by combining staff responses to three to five or more items into a single index. Employing indices will greatly facilitate the analysis and reporting of the Staff Study. They have been subject to a Cronbach’s alpha test for consistency. The reliability scores for these indices are found in the appendix. Only the high scores in these indices is reported here, while more details are available in a separate document on indices. Missing data above 5% is noted in a separate file in the appendix.
A. Employment conditions at the hospital The first series of questions concern employees’ current work conditions, including their occupation, employment form, current position, length of employment, hours worked per week and per day and whether their work involves acute medicine or not etc. Q1: Current occupation*
Med Co-ops
Koseiren
Public
Dif. (h-l)**
Doctor***
2.3
7.0
7.1
4.8/P
Nurse
26.2
47.5
56.2
30.0/P
Care worker****
33.5
4.2
0.6
32.9
Other medical specialist
16.9
17.8
14.3
2.6/K
Administrator
16.0
14.2
19.4
5.2/P
Other, div. support
4.6
8.7
2.4
6.3/K
Missing data
0.5
0.5
0.4
0.1
Total
2,852
2,562
1,445
--
*adds column wise, percent of total; ** difference between high and low; ***The average for doctors includes two strong outliers, Toyota with 10.0% doctors and Himeji with only 0.7% doctors; ****The average for care workers includes the same two outliers, Toyota with only 2.4% care workers and Himeji with 55.7%.
The largest differences are noted in the occupational categories, nurses and care workers. More than half of the total staff at public hospitals are nurses, and nearly half at Koseiren hospitals, compared with barely one in four at the Medical Co-ops. One third of the staff at the Medical Co-ops are care workers, while only a fraction of the staff is employed as care workers at the Koseiren and public hospitals. Otherwise differences between them are small in terms of occupation.
3 Q2: Employment form*
Med Co-ops
Koseiren
Public
Dif. (h-l)**
Full-time, permanent***
56.8
77.2
66.9
20.4/K
Fixed term contract
4.1
6.6
7.8
3.2/P
Commissioned staff
1.4
3.2
4.2
2.8/P
Temporary agency personnel
0.1
2.8
2.2
2.7/K
Part-time temporary staff
37.0
9.6
15.5
27.4
*adds column wise, percent of total; ** difference between high & low; ***Saku has a larger proportion of full-time employees (94.1%) than other Koseiren hospitals, and Toyota has far fewer (77.7%), while Himeji has far more part-time employees (55.0%) than other Medical Co-op hospitals.
The proportion of full-time permanent staff is more than three fourths at Kosieren hospitals, about two thirds at public hospitals, and less than three of five at the Medical Co-ops. By contrast, at the latter nearly two fifths are part-time, temporary staff. This probably reflects differences in their local labor markets, human resource policies as well as the role they play in the local community. Q3: Position at the hospital*
Med Co-ops
Koseiren
Public
Dif. (h-l)**
Manager***
12.1
8.8
13.4
4.6//P
Staff with title
5.3
6.9
5.7
1.6/K
Non-managerial
78.6
81.5
77.4
4.1/K
Board member
0.9
1.4
0.1
1.3/K
*percent of total; ** difference between high and low; *** nearly half (48.6%) of the doctors claim a managerial position.
Only small differences exist between these three hospital groups in terms of the proportion of staff with managerial and non-managerial positions. Q4: Length of employment at the hospital*
Med Co-ops
Koseiren
Public
Dif.(h-l)**
Less than one year
12.0
9.0
13.7
4.7/P
1 to 5 years
33.8
29.2
33.4
4.6
5 to 10 years
23.8
21.0
20.1
3.7
Over 10 years
29.5
40.0
31.9
10.5/K
*percent of total; ** difference between high and low.
Between one third and one half of the staff has worked five years or less at all three hospitals, and two of five Koseiren employees have worked ten years or more, while less than a third has done so at the two other hospital groups. This probably reflects differences between their local labor markets, where there are more opportunities to change jobs and greater staff turn-over in the cities than in rural areas. Q5: Hours worked per week*
Med Co-ops
Koseiren
Public
Dif. (h-l)**
Less than 15 hours per week
11.2
6.0
11.2
5.2
Between 15 and 29 hours
19.9
7.0
19.8
12.9
Between 30 to 39 hours
22.4
20.5
22.4
1.9
4 Between 40-49 hours
34.7
45.7
34.7
11.0/K
More than 50 hours per week
11.8
20.9
11.7
9.2/K
*percent of total; ** difference between high and low.
The staff at Koseiren hospitals have longer work weeks than staff at either the Medical Co-ops or public hospitals. About two thirds of the staff at Koseiren hospitals work 40 plus hours per week, while less than half of them do so at Medical Co-ops and public hospitals. Q6: Average hours worked per day*
Med Co-ops
Koseiren
Public
Dif. (h-l)**
Less than 6
16.1
4.2
4.6
11.9
6 to 7
22.1
9.7
16.9
12.4
8
32.0
43.9
26.1
17.8/K
9
17.4
19.4
18.7
2.0/K
10
8.8
14.7
21.9
13.1/P
11 and more
3.5
8.2
11.9
8.4/P
*percent of total; ** difference between high and low.
The staff at public hospitals have longer work days than the staff at the other two hospital groups. The staff was also asked whether they worked primarily with acute medicine or not and whether they worked mostly daytime or nighttime. Q7a: Work mainly with acute medicine*
Med Co-ops 16.9
Koseiren 42.0
Public 69.3
Dif. (h-l)** 52.4/P
Q7b: Mainly daytime*
83.9
77.6
68.5
15.4
*percent of total; ** difference between high and low.
More than two thirds of the staff at public hospitals (69.3%) work with acute medicine, while many fewer do so at the Medical Co-ops (16.9%) and Koseiren (42.0%) hospitals. Between two thirds and more than four fifths of the staff at all three hospital groups work mainly at daytime. A profile of the Medical Co-op respondents shows that there are fewer doctors and nurses than at the other two hospital groups, but many more care workers. More than one-third are part-time employees, which is well above the other two hospital groups. Nearly half have of them been employed five years or less, so there are more new recruits. They have a shorter work week (30 hours or less) and a shorter work day than their colleagues at Koseiren, just under half work 40 hours or more. Finally, very few, less that one of five, work in acute medicine and more that four of five work daytime. Given their shorter work week and work day they can more easily achieve a work/family balance that employees at the two other hospital groups. A profile of the Koseiren respondents shows that there more doctors and nurses and many fewer care workers, similar to the public hospitals. More than three quarters are employed full-time and two of five have worked for a Koseiren hospital 10 years or more. This suggest more secure, long-term employment. Moreover, they have the longest work week of all hospital groups and nearly two thirds work between 8 to 9 hours per day.
5 Two of five work in acute medicine and more than two thirds work daytime. Thus, they seem to have the most permanent and secure employment. A profile for the public hospital respondents shows that there are more doctors and nurses and almost no care workers at public hospitals. Two-thirds of them work full-time and nearly half have worked for a public hospital for five years or less. Less than half of them work 40 hours per week, but many more claim that they work 10 hours or more per day, for the longest work day of all hospital groups. More than two-thirds work in acute medicine and a similar proportion work daytime.
B. Value of work questions. The staff was asked to state how important three different aspects of work were when they first chose their current job. Two of these three aspects are considered expressive or social values, while the third is related to instrumental values, providing stable work. The table below only includes the proportion of positive alternatives. Q8: Importance at the beginning*
Med Co-ops
Koseiren
Public
Dif. (h-l)**
Provides stable work
80.9
83.7
91.4
10.5/P
Commitment to community activities
53.2
39.1
35.8
17.4
Cooperative form/***
33.9
27.6
Na
6.3
*indicates proportion of positive answers (important & somewhat important) to these aspects of their job initially; ** difference between high and low; *** Different questions were posed to the staff at different hospital groups, so only the answers for the Medical Co-ops and Koseiren will be compared here. Na=not available.
In general, the staff at all three hospital groups agree about the importance for taking their job. Having stable work clearly outweighs social issues and they rate it much higher than commitment to the community. However, the staff at Koseiren hospitals and Medical Co-ops pay less importance to having a stable job than the staff at public hospitals. Commitment to community activities received support from one third to one half of the staff in these hospital groups. Questions concerning organizational form differed, and therefore, cannot be compared. Turning to what are currently the most important values for employees we note the following pattern of answers. Q9: Important values now*
Med Co-ops
Koseiren
Public
Dif. (h-l)**
Provides stable work
82.5
85.9
92.7
10.2/P
Easy to commute
81.6
82.1
87.2
5.6/P
Good hours/fits your lifestyle
79.1
71.0
79.5
8.5/P
Good salary compared w similar jobs locally
52.9
54.8
72.1
19.2/P
Commitment to community activities
55.1
44.2
40.1
15.0
Clear social mission
50.5
41.4
44.0
9.1
Cooperative form/***
33.9
27.6
Na
6.3
Friends & acquaintances work here****
14.0
15.3
12.1
3.1/K
*Indicates percent positive answers (important & somewhat important); ** difference between high and low; *** Different question, so only the answers for the Medical Co-ops and Koseiren will be compared here; ****note there is a lot of MD or non-answers for this alternative, indicating a reluctance to answer it or to consider it relevant. Na=not available
The answers provided by hospital staff show a clear pattern. Four instrumental aspects, i.e., providing stable
6 work, ease of commute, good hours that fit their lifestyle and a good salary receive the highest positive scores, ranging from half to more than nine of ten positive answers. These items get higher positive scores from the staff at public hospitals than the staff at either the Medical Co-ops and Koseiren. This suggests a somewhat stronger instrumental orientation at public hospitals. Shifting focus to social values like commitment to community activities and having a clear social mission, such items receive support from over one third to one half of the staff at the three hospital groups. The question about the importance of the organizational form was phrased differently, so their answers are not comparable. Finally, only about one in ten staff at the three hospital groups mention having a friend or acquaintance at work as being important, while more than three fifths of them state the latter is not important. Moreover, there is a lot of missing data for this item, so this item will not be used in our analysis. (See the appendix for questions with lots of missing data.) Two indices of important values were calculated, one from the four instrumental values and another from the three social values found in the items of Question 9. These indices were divided into three equal parts, high, medium and low. Only the high values for each hospital group are shown below. Q9. Index important values
Med Co-ops
Koseiren
Public
Dif. (h-l)**
Instrumental values (high scores)
29.9
28.1
35.9
7.8/P
Social values (high scores)
37.5
27.8
22.4
15.1
Index scores for the instrumental values show stronger support from the staff at public hospitals, while support for social values is strongest for the staff of Medical Co-ops. The latter give more support to social than instrumental values, while the opposite pattern is found among the staff at public hospitals. The staff at Koseiren falls in between the other two hospital groups. Three additional items reflect the staff’s general satisfaction with their current job situation, their overall work satisfaction, their ability to take paid holidays and their monthly salary. Answers for these questions only include the positive answers, in spite of a large number of negative answers to two of these three items. Q10: Satisfaction with work issues*
Med Co-ops
Koseiren
Public
Dif. (h –l)**
Work overall
54.4
42.9
41.4
13.0
Ability to take paid holidays
49.7
31.5
36.7
18.2
Salary (monthly + bonus)
30.8
25.1
41.6
16.5/P
*Indicates only the percent of positive (agree & somewhat agree) answers; ** difference between high and low.
The staff at Medical Co-ops express the highest level of overall satisfaction with their work and those at public hospitals the lowest. Staff at the Medical Co-ops give more support to their ability to take paid leave and staff at Koseiren hospital the least. Staff at both types of co-op hospitals are clearly less positive about their salaries than staff working at public hospitals.
C. Work Environment/work conditions.
7 1. How meaningful is your work? The staff at these hospital groups were asked to indicate their agreement with five items under the heading meaningfulness of work. Q11: Meaningfulness of work
Med Co-ops
Koseiren
Public
Dif. (h-l)**
My work is worthwhile
75.0
68.1
64.4
10.6
My work contributes to society
62.5
55.3
53.2
9.3
My work is interesting & stimulating
60.3
53.6
55.1
6.7
I am able to use my skills & talents
53.8
44.9
45.0
8.9
I feel needed at work
49.7
42.4
41.5
8.2
*Indicates percent of positive answers (agree & somewhat agree); **difference between high and low.
The staff at Medical Co-ops is more positive on all five items, while the staff at public hospitals is least positive on three of these five items. Between three-fifths or more of the staff at all hospital groups agreed that their work was worthwhile. Between half and nearly two-thirds of them felt that their work contributes to society, is interesting and that they were able to use their skills and talents. Slightly less than half of them claimed to feel needed at work. The staff at these hospital groups had similar opinions about the meaningfulness of their work and differences between them were modest. An Index of Work Satisfaction based on the five items included in Question 11, together with one item in Question 10 on overall work satisfaction, was calculated. Q 11. Index of Work Satisfaction
Med Co-ops
Koseiren
Public
Dif. (h-l)*
Work satisfaction, high scores only
37.5
28.6
24.8
12.7
*difference between high and low.
The results below confirm that the staff at Medical Co-ops is more satisfied with their work than staff at Koseiren and public hospitals. 2. Work demands The staff was then asked to state their agreement with four items about workplace demands or the intensity of their work load. They include having time to talk with their colleagues, the work load being appropriate, having too much overtime and the staffing being adequate. Q12: Demands at work*
Med Co-ops
Koseiren
Public
Dif. (h-l)**
There is sufficient time to talk w colleagues
42.7
47.0
34.5
12.5/K
The current work load is appropriate
44.7
39.0
32.5
12.2
There is too much overtime work
22.9
29.6
41.3
18.4/P
The staff is sufficient
21.8
15.9
12.3
9.5
*Indicates percent of positive answers (agree & somewhat agree); **difference between high and low.
Positive answers to most of these items concern a degree of reasonableness in terms of job demands. Having sufficient time to talk with colleagues, an appropriate work load and sufficient staff seems more reasonable than not having them. Yet, the proportion of staff claiming reasonable demands is low compared with other items
8 included in this study. Less than half of the staff at these hospital groups claim there is sufficient time to talk with colleagues. Similar proportions claim that their work load is appropriate. About a quarter of the staff at the Medical Co-ops and Koseiren hospitals claim there is too much overtime, while more than two of five claim this at public hospitals. Nearly one fifth of the staff at Medical Co-ops claim that the staff is sufficient for its work load, while barely one of eight does so at public hospitals. Public hospitals came lowest on the three positive aspects, but highest on the negative aspect, i.e., too much overtime. This indicates a more demanding work environment at public hospitals. An Index of (Reasonable) Job Demands was calculated by combining the four items in Question 12 with the two items in Question 17. It was divided into three equal parts, high, medium and low. The results for this index are found below and differences between the staff groups are not large. Qs12+17. Index of (Reasonable) Job Demands Job demands (only high scores)
Med Co-ops
Koseiren
Public
Dif. (h-l)*
40.5
34.0
24.1
16.4
*difference between high and low.
The staff at Medical Co-ops give more support to claims of ‘reasonable’ job demands than the staff at Koseiren hospitals, while the staff at public hospitals express much lower support for these items than the other two hospital groups. 3. Human resources and social support The staff then answered questions about their relations with colleagues and the social support at work. They included questions about items like gender discrimination, having someone to talk with about work-related problems, having good relations with colleagues and subordinates, also with their boss and everyone being treated fairly at work. The staff at the Medical Co-ops give highest support to these items and differences between three staff groups is moderate, while the staff at public hospitals showed the lowest level of support again. Q13: Social support*
Med co-ops
Koseiren
Public
Dif. (h-l)**
Don’t experience gender discrimination at work
83.3
78.0
75.5
7.8
There is someone to talk to about problems at work
75.6
73.6
67.1
8.5
Have good relations with colleagues & subordinates
75.4
72.6
68.7
6.7
Have good relations with my boss/superiors
71.1
66.0
57.8
13.3
Everyone is treated fairly at your workplace
53.7
44.8
39.8
13.9
*Indicates percent of positive answers (agree & somewhat agree); **difference between high and low.
An Index of Social Support was calculated from the five items in Question 13. It was divided into three equal parts, high, medium and low. Only the high values are indicated for this index below. Q13. Index Social Support Social support (only high scores) *difference between high and low.
Med Co-ops
Koseiren
Public
Dif. (h-l)*
39.8
29.7
24.1
15.7
9 The Index of Social Support indicates that highest levels of agreement with questions related to social support at work come from the staff at Medical co-ops, where two of five are positive, while one of four or more are positive concerning such items at Koseiren and public hospitals. This implies stronger social support at the former hospital group than the latter two. 4. Exercising discretion or control The staff also answered four questions about how much discretion they had over their work. This comprises the ‘nuts and bolts’ of workplace control, being able to decide the what, when, where and how they fulfill their daily tasks at work. This includes questions like having lots of control, being able to work at their own pace, being able to adjust their work load, and given sufficient authority to fulfill their duties. Differences between the three staff groups seem rather large. Q14: Control at work*
Med Co-ops
Koseiren
Public
Dif. (h-l)**
Have lots of control over the order & way tasks are performed
59.0
50.9
44.8
14.2
You can work at your own pace
47.7
39.4
29.6
18.1
You are able to adjust your work load
46.9
38.0
29.1
17.8
You are given sufficient authority to fulfill duties
41.2
37.4
30.8
10.4
*Indicates percent of positive answers (agree & somewhat agree); **difference between high and low.
The staff at Medical Co-ops appear to have the most control on these items, where support ranged from three of five to two of five staff members, while staff at public hospitals have the least control. An Index of Control was calculated from the four items in Question 14. It was divided into three equal parts, high, medium and low, similar to several other indices for questions related to work environment. Only the high scores are reported below. Q14. Index of Control Control (only high scores)
Med Co-ops
Koseiren
Public
Dif. (h-l)*
40.1
33.3
22.9
17.2
*difference between high and low.
The staff at Medical Co-ops appear to have the most control over the’ nuts and bolts’ of their daily work, while those at public hospitals appear to have the least. Two of four claim high control in the former, while only one of five does so in the latter. In fact, twice as many claim low control as those that claim high control at public hospitals. 4. Influence at work The three items found under the heading of influence at the workplace include the existence of sufficient structures and opportunities for expressing their opinion, the perceived ease of expressing their opinion and having their suggestions and opinions reflected in decisions. Support for these items ranges from the high 50s and low 40s to the high or mid-30s on most items, but we note some clear differences between the staff at the hospital groups. The staff at the Medical Co-ops expresses most support for these items, followed by the staff at Koseiren hospitals, while the staff at public hospitals comes last on all aspects of influence. This is not an unexpected finding and probably reflects the bottom-up, democratic decision-making structures at Medical Co-
10 ops, compared with a hierarchical top-down model practiced by public hospitals. Q15: Influence at work*
Med Co-ops
Koseiren
Public
Dif. (h-l)**
Sufficient structures & opportunities for expressing my opinion
59.1
47.3
38.1
21.0
It is easy to express my opinion
55.0
42.1
34.1
20.9
My suggestions and opinions are reflected (in decisions)
48.1
38.9
28.9
19.2
*Indicates percent of positive answers (agree & somewhat agree); **difference between high and low.
An Index of Influence at work was calculated from the three items in Question 15. It was divided into three equal parts, high, medium and low, similar to several other indices for questions related to work environment. The results are found below, and differences between the three staff groups are notable. Q15. Index Influence at Work
Med Co-ops
Koseiren
Public
Dif. (h-l)**
42.2
31.6
23.8
18.4
Influence (only high scores) *difference between high and low.
Once again, we can note a similar pattern, in terms of influence at work. The Medical Co-ops appear willing to grant the staff more influence at work than either Koseiren and public hospitals. The public hospitals rank lowest in terms of influence, which probably reflects their hierarchical command and control organization model. 5. Personal and professional development The three items found under the heading professional and personal development include feeling that they developed through work, the existence of good education and training opportunities and good prospects for promotion and career development. Q16: Professional and personal development*
Med Co-ops
Koseiren
Public
Dif. (h-l)**
You feel that you developed through work
63.7
58.2
52.3
11.4
Good education and training opportunities are provided
56.2
47.7
53.2
8.5
Good prospect for promotion and career development
25.8
19.0
21.4
6.8
*Indicates percent positive answers (agree & somewhat agree); **difference between high and low.
The first two items get support from between 50 and 60 percent or more of the staff at these three hospital groups, while the third question on career possibilities receives considerably less support from all hospital groups, only in the mid-20s or lower. The staff at Medical Co-ops was most positive about all of these questions and the staff at Koseiren hospitals least positive about two of them. An Index of Personal Development was calculated from these three items. It was divided into three equal parts, high, medium and low, but only the results for the high scores are found below. Differences between the two hospital groups are rather notable. Q16. Index Pers Development Prof. development (only high scores) *difference between high and low.
Med Co-ops
Koseiren
Public
Dif. (h-l)*
45.9
35.6
36.4
10.3
11 The Medical Co-ops appear well above the other hospital groups in terms of personal and professional development. Nearly half of the staff there rank them high, while only a third do so at the other two hospital groups. 6. Work-life balance Two questions reflect the thorny issue of work-life balance. They are related to the staff’s ability to combine or balance work-life demands with their family or private life. They were questions about the ease of getting leave for childcare and/or eldercare. Nearly half the staff of all three hospital groups felt they could take a leave for childcare, while one fifth to one third felt the same about eldercare. Here the Medical Co-ops rated better than the other two healthcare providers. However, only approximately one of eight employees claim that they have, in fact, taken a leave for childcare, while barely 2.5% did so for eldercare. Again, we find similar patterns of agreement/disagreement with these questions, and the difference between their levels of support was not very great, except for eldercare. Q 18: Ease of getting leave for* -Childcare
Med Co-ops
Koseiren
Public
Dif. (h-l)***
53.6
46.7
47.8
6.9
-Eldercare
34.2
23.9
19.9
14.3
Q 18: Taken leave for** -Childcare
Med Co-ops 10.8
Koseiren 17.9
17.3
Dif. (h-l) 7.1/K
-Eldercare
2.7
2.3
2.8
0.5/P
*Indicates percent of positive answers (agree & somewhat agree); ** Yes and No answers for this question; ***difference between high and low.
An Index of Work-Life Balance was calculated on the basis of the two questions concerning the ease of getting leave for childcare and/or eldercare. The division of high staff responses is found below. Once again the Medical Co-ops gain more support from the staff on this count than the staff at the other two hospital groups. Q18. Index of Work-Life Balance Ease of getting leave (only high scores)
Med Co-ops
Koseiren
Public
Dif. (h-l)*
40.4
29.2
27.0
13.4
*difference between high and low.
Comments were provided by the staff of the two cooperative providers of healthcare concerning these questions on their work environment and work-life. They are not yet available for the public provider. Question 19 provided respondents space to comment on what kind of improvements they wish to make in their employment/work environment. Only the three most mentioned alternatives are included below. Q. 19: Comments on work environment
All hospitals
Med Co-ops
Koseiren
Dif. (h-l)**
1. Securing (more) personnel
6.0
6.4
5.6
0.8
2. Easier access to vacation time
1.9
0.9
2.9
2.0
3. A pay raise
1.6
1.8
1.4
0.4
M D*
89.6
89.5
89.8
--
Totals
5,414
2,852
2,562
--
*MD indicates the proportion of respondents who did not provide a written comment to this open question; **difference
12 between high and low.
Only about 10 percent of the staff provide comments on improving their employment or work condition, but among those who do there is a large degree of consensus about things they would like to do, hiring more staff, pay increases, and more flexible vacation time. Staff at Koseiren hospitals appear concerned about getting more flexibility for planning their vacation. 6. Networking: contacts with key stakeholders Finally, we turn to the network activities of the staff and hospitals. The staff were asked about their interactions with key stakeholders, including patients, other healthcare providers, volunteers, members of the co-ops, local community members, local government officials, and others. Question 20 asks how often they talk with various groups about issues related to their hospital. Question 21 concerns their hospital’s efforts to engage with the same groups. Such questions reflect the existence of channels for and willingness to engage in a dialog with various stakeholders, both inside and outside the hospital. There seems to be a high degree of consensus concerning who are the most important stakeholders for the staff at all the hospitals. Patients, other healthcare providers and volunteers are the three most important groups, but the strength of contacts with each of these stakeholders varies considerably between hospital groups. Patients comprise a unique stakeholder, since they are also hospital clients and it is natural to expect staff to talk with them more or less regularly. Contacts with them receive support from two thirds of the staff at Medical Co-ops, while they get support from half of the staff at Kosieren and public hospitals. Q20: Talk with…*
Med Co-ops
Koseiren
Public
Dif. (h-l)**
Patients
68.8
53.7
50.9
17.9
Other healthcare providers
35.3
32.2
31.4
3.9
Volunteers
31.1
19.3
16.2
14.9
Members of JA/ Med Co-ops
19.8
10.0
Na
9.8
Members of the local community
18.6
11.5
7.7
10.9
Local government officers
9.0
5.7
6.1
2.0
Others, specify***
11.7
7.0
7.1
4.7
*Indicates percent of positive answers (often & sometimes); **difference between high and low; ***Missing data was over 75%, so these answers will therefore not be included in our analysis. Na=not available, this question/alternative was not available for staff at public hospitals, so the difference only reflects the Medical Co-ops and Koseiren.
Contacts with other healthcare providers gets more support from Medical Co-ops than the other two healthcare providers, as too does contact with volunteers. But, we noted much lower levels of discussion with the three other stakeholders in Question 20. Turning to the hospital’s engagement with outside groups, we can note the following pattern in question 21. Q21: Engage with these stakeholder groups*/***
Med Co-ops
Koseiren
Public
Dif. (h-l)**
Patients
84.8
66.1
65.2
19.6
Other healthcare providers
55.3
39.0
---
16.3
13 Volunteers
64.3
41.8
36.6
27.7
Members of JA/ Med Co-ops***
47.3
28.7
Na
18.6
Members of the local community
30.0
50.3
20.4
29.9/K
Local government officers
33.6
23.1
20.4
13.2
Others, specify***
11.1
8.4
8.9
2.7
*Indicates percent of positive answers (often & sometimes). Missing data ranged from 0.8 to 1.9%; **difference between high and low; ***Missing data is very large for Question 21. See Table B in the Appendix for details about missing data; and Na=not available, this question/alternative was not available for staff at public hospitals, so the difference only reflects the Medical Co-ops and Koseiren.
Engaging with patients, volunteers and members of the local community are the three most important items. Unfortunately, the staff at public hospitals did not receive the chance to reply to engaging with other health care providers and the question about contacts with their respective organizations was different, so their answers are not comparable. An Index of Networking was calculated from three of the items in Question 20 for contacts with stakeholders. They included contacts with patients, volunteers and local community groups. Similar to the other work environment indices, the Index of Networking was divided into three roughly equal parts, high, medium and low. The results for the high scores are found below. Q 20. Index for networking
Med Co-ops
Koseiren
Public
Dif. (h-l)*
35.1
21.0
16.2
18.9
Networking (only high scores) *difference between high and low.
Staff at the Medical Co-ops reports twice as frequent contacts with these three stakeholders as do staff at public hospitals.
D. Patients’ rights, information policy & hospital standards. This suite of questions is related to professional standards concerning patient/user privacy, making information more readily accessible and understandable. Q24: Patients’/users’ privacy, dignity and rights*
Med Co-ops
Patients’/user’s personal information is protected
83.7
Patients’/users’ dignity and privacy are protected Patients’/users rights are clearly stated & protected
Koseiren
Public
Dif. (h-l)**
79.7
85.4
5.7/P
78.8
76.9
82.9
6.0/P
81.7
71.0
79.2
10.7
*Indicates percent of positive answers (agree & somewhat agree); **difference between high and low.
The staff at all three hospital groups rate patients’ privacy, dignity and rights very high, as would be expected. This is a central part of their professional standards, training and socialization. The general range is between 70 and 85 percent support for such matters. The public hospitals rate best on two of these three items. The staff was also asked about making information and medical explanations more understandable to laymen and
14 laywomen in four questions related to this topic. Once again, high levels at all three hospital groups appear to promote ideas of facilitating greater patient understanding, making treatment plans more transparent, improving communications, etc. This seems to be part of their professional standards, and the difference between these three hospital groups is moderate, with slightly more support expressed by the staff at the Medical Co-ops. This probably reflects the fact that they have adopted a Patients’ Bill of Rights. Q25: Making information & explanations more understandable*
Med Co-ops
Koseiren
Public
Dif. (h-l)**
Explanations are made clearly to facilitate understanding
77.5
71.1
78.1
7.0/P
Information about medical treatment & eldercare is shared with patients or users
75.9
68.4
74.9
7.5
Efforts are made to establish support systems for patients or users and for improving communication
74.7
65.1
69.1
9.6
Efforts are made to improve patients’/users’ understanding about their medical/eldercare
70.4
60.6
64.7
9.8
*Indicates percent of positive answers (agree & somewhat agree); **difference between high and low.
An Index of Patient Rights and Information was calculated from the three items in Question 24 and four items in Question 25. It was divided into three equal parts, high, medium and low, similar to several other indices for questions related to work environment. The results are found below and differences between the three staff groups are moderate, rather than large. The staff at Medical Co-ops rate themselves higher and the Koseiren hospitals rate themselves lower on this index than the staff at public hospitals. Q 24/5. Index of Patients’ Rights
Med Co-ops
Koseiren
Public
Dif. (h-l)*
39.6
30.5
34.8
9.1
Pat. Rights & Info. (only high scores) *difference between high and low.
E. Hospital Standards and Service Quality Then come three questions that are related to hospital standards and service quality. About one-third of the staff at both hospital groups express positive attitudes on all three questions about the services at their hospital. However, please note that the staff at all hospital groups appear to have some difficulty answering these questions, as seen in a large proportion choosing the ‘neither’ alternative. It probably functions as a ‘don’t know’ or ‘won’t say’ alternative and such answers are, in fact, more frequent than positive responses to these questions. Q26: Hospital standards*
Med co-ops
Koseiren
Public
Dif. (h-l)**
Higher than other providers
41.7
39.2
45.6
6.4/P
High quality equipment is in place
27.1
49.5
53.7
26.6/P
Technical skills of the staff are high
35.7
36.3
38.9
3.2/P
*Indicates percent of positive answers (agree & somewhat agree); **difference between high and low.
The staff at the public hospitals rate their hospital higher than the staff at the other hospitals all of these items. However, the unusual high degree of uncertainty noted earlier makes response to these three questions appear a
15 bit unreliable. See appendix for details of missing data. The staff was also asked to rate the overall quality of the services provided by their hospital (Question 23) and whether they would recommend it to a relative, friend or neighbor (Question 27). Questions on service quality
Med Co-op
Koseiren
Public
Dif. (h-l)*
Q23 Rate the hospitals’ service**
71.1
62.4
63.9
8.7
Q27 Recommend the service***
55.0
44.7
41.2
13.8
*difference between high and low; **Indicates percent of positive answers (good & rather good); ***Indicates percent positive answers (agree & somewhat agree).
Three fifths or more of the staff at all three hospitals feel that the overall quality of the services they provide is good, while the staff at the Medical Co-ops rate them higher than the other two staff groups. When it comes to recommending it to others, more than half of the staff at the Medical co-ops indicate a willingness to do so, while closer to two of five do so for the Koseiren and public hospitals. An Index of Service Quality was calculated, based on Questions 23 and 27. It was divided into two equal parts, high and low. The frequency distribution made it difficult to divide it into the three categories employed by the other indices in this report. Furthermore, question 26 was not included in this index because an exceptionally large proportion of the staff at all hospital groups used the “neither agree nor disagree” alternative when answering these items. This suggests that they were unable to make such comparison since they probably have no insights into the standards at other hospitals. When this “don’t know” alternative becomes the major response alternative, it makes the use of such items in an index precarious and could introduce a high degree of uncertainty into an index. Q 23+27. Index of Service Quality Service Quality (only high scores)
Med Co-ops
Koseiren
Public
Dif. (h-l)*
53.0
41.8
40.5
12.5
*difference between high and low.
The staff at the Medical Co-ops clearly claim higher levels of service quality than the staff at Koseiren hospitals, while staff at public hospitals show the lowest level of support for service quality. Question 28 asks respondents to contribute their own comments about the quality of medical and elderly services provided by their hospital or eldercare workplace. Results are not yet available in English.
F. Social dimensions of co-op and public healthcare. Agricultural and consumer co-op health and eldercare is not primarily provided for economic or financial reasons, but rather to promote their members’ interests and other social values. What social values do these two hospital groups promote in the provision of health and eldercare? Questions 31, 32, 34 and 35 address the social values promoted by cooperative health and eldercare. Question 32 is a more general question about the staff’s perception of their hospital’s social mission, does it make a contribution to society beyond providing health care? Question 31 addresses the hospitals’ social values, question 32 asks whether the staff feels their hospital does in fact make a contribution to society, question 34 asks about the most important issues/activities for their hospital, while question 35 enquires about their support for the statement “patients first, business second”.
16 Finally, question 36 asks about the staff participation in “extra curricular” or non-work activities promoted by their hospital. Question 32 asked the staff for their general evaluation about their hospital’s contribution to society, above and beyond the medical services provided to the local community. Q32: makes a contribution to society*
Med Co-ops
Koseiren
Public
Dif. (h-l)**
Yes
41.7
37.4
29.6
12.1
*Indicates percent of positive answers (agree & somewhat agree); **difference between high and low.
The staff at two of the hospital groups, Medical Co-ops and Kosieren, seems more positive about their hospital’s social contribution to society than the staff at public hospitals. Question 31 ask the staff about the social values promoted by their hospital. The staff could choose three alternatives that describe their hospital’s social contribution to the community. Staff support for these social values shows some similarities, but also some notable differences. Beginning with the similarities, ‘community integrated care’, ‘promoting local development’ and ‘care for the uninsured’ get somewhat similar levels of support from the staff of all three hospital groups and the difference between them is moderate. Community integrated care is ranked number one by the staff at Koseiren and public hospitals, and it comes number two for the Medical Co-ops. Regarding the differences between them, there is a considerable gap concerning their support for ‘promoting patient and user participation in healthcare’. It is ranked first by the staff at the Medical Co-ops and second or third by the other two hospital groups. Yet, the level of support by the staff at Medical Co-ops is more than twice that of the staff at public hospitals. Similarly, ‘promoting preventive healthcare’ gets twice as much support from the Medical Co-op staff as the staff at public hospitals. In addition, ‘creating jobs in the local area’ and ‘providing health and elder care in areas of short supply’ get much stronger support from the staff at Koseiren hospitals than the staff at the two other hospital groups. Note that these two alternatives are combined into a new alternative, ‘makes services and jobs available in areas of short supply’, found in italics at the bottom of the table. As might be expected, staff at Koseiren give the new alternative much more support than the staff at the other two hospital groups. In fact, once combined it becomes the social value that gets most support from the staff at Koseiren. Finally, the staff at public hospitals lends more support to ‘providing highly skilled jobs in the local area’, by a sizable margin. Also, please note that there are some ‘don’t know’ answers that might be the third choice for respondent who provided two other answers. More staff at public hospitals employed this answer that the staff at the other two hospitals. Summarizing the similarities and differences between the hospital groups allows us to propose a social profile that can be equated with each hospital’s social mission. The staff at the Medical Co-ops are most adamant about ‘promoting patient participation’, ‘community integrated care’, ‘preventive healthcare’, ‘local development’, and ‘promoting health and eldercare for the uninsured’, in that order. The staff at Koseiren hospitals give most support to ideas of ‘making services and jobs available in areas of short supply’ ‘integrated community care’, ‘promoting patient participation’ and ‘preventive health care’, clearly indicating more support among the staff of Koseiren hospitals for issues related to shortages in rural areas. This is logical since such things are often in
17 short supply in rural areas, and they are important for trying to prevent depopulation and stave off urban drift. The staff at public hospitals focus more heavily on ‘community integrated care’, ‘providing high skilled jobs in their local area’, and ‘patient participation’, in that order. Q31: Social mission &/or contribution to the local community*/***
Number of responses
Med Coops
Koseiren
Public
Dif. (h-l)**
Promotes community based integrated care
3,199
53.1
46.7
39.6
13.5
Promotes patient & user participation in healthcare
3,113
65.6
36.2
27.4
38.2
Promotes preventive healthcare
2,601
50.1
35.9
22.2
27.9
Creates jobs in the local area****
1,688
18.4
33.5
24.2
15.1/K
Provides high skilled jobs (drs/nurse) in the local area
1,250
5.7
24.1
34.8
29.1/P
Promotes local development
1,181
21.3
17.0
11.7
9.6
Provides health and elder care in areas of short supply****
1,001
11.7
24.2
5.1
19.1/K
Provides health & eldercare to the uninsured
839
18.9
7.1
9.6
11.8
Provides training and jobs for women locally****
465
6.5
6.1
9.1
3.0
Helps prevent depopulation****
88
0.2
0.9
1.1
0.9
Don’t know
1,339
14.0
19.0
33.7
19.7/P
Missing data
175
2.5
2.6
2.6
****makes services & jobs available in local area
3,240
37.2
66.0
39.5
28.2/K
*Respondents could choose three alternatives; **difference between high and low; ***average number of alternatives chosen was 2.71 for the Medical Co-ops, 2.64 for Koseiren and 2.41 for Public; ****‘makes services and jobs available in local areas’ combines these four answers.
Thus, the social mission of Medical Co-ops emphasizes patient participation and preventive medicine, or coproduction, the social mission at Koseiren supports making community integrated care services and jobs available in rural areas, while the social mission of public hospitals ‘promote community integrated care’ and ‘making high skilled jobs available in local areas’, or more traditional professionalism in healthcare. Question 34 asks the staff about the most important issues or challenges facing their hospital. They could choose three of the eight alternatives. There is a high degree of consensus among the staff on the three most important issues facing their hospital, and a large degree of agreement in the importance they attribute to them. They focus heavily on the first two items, while support for the following items decreases considerably. There is a clear emphasis on providing good quality health and eldercare in the local area and promoting good working conditions for the staff at all three hospital groups. Between half to three of four staff members at the hospitals chose both these alternatives.
18 Q34: Three most important issues*
No. of responses**
Med Coops
Koseiren
Public
Dif. (h-l)***
Provide good quality health/eldercare in the local area
4,548
60.6
72.1
75.0
14.4/P
Promote good working conditions for the staff
4.040
56.5
62.4
64.4
7.9/P
Maintaining a healthy/sound budget
2,499
36.7
38.3
36.9
1.6/K
Promoting patient & user participation in healthcare
2,287
43.3
30.5
22.9
20.4
Increasing patient/bed turnover
1,650
26.3
24.5
21.9
4.4
Increasing the financial surplus
903
10.9
16.4
13.4
5.5/K
Promoting clear organizational goals
853
16.7
9.3
11.0
7.4
Working with municipal and/or national governments
553
10.2
6.5
7.6
3.7
Don’t know
447
3.0
2.1
1.9
1.1
Missing data
168
6.8
6.1
7.9
1.8/P
Totals
17,779
7,407
6,672
3,700
73.9
79.2
72.2
Sound financial management****
7.0/K
*Respondents could choose up to three answers; **the average number of responses is 2.68 for the Medical Co-ops, 2.66 for Koseiren and 2.60 for public hospitals; and ***difference between high and low; ****combines the answers maintaining a healthy budget, increasing patient/bed turnover and increasing the financial surplus.
Then comes a set of answers that get support from between a third and quarter of the staff in general. They are related to maintaining a healthy/sound budget, promoting patient and user participation and increasing patient/bed turnover. However, we can note one major difference between the staff at the hospital groups. The staff at Koseiren and public hospitals feel stronger about providing good quality health and eldercare in the local area, while the staff at the Medical Co-ops felt more strongly about promoting patient and user participation in healthcare. Finally, questions about increasing the financial surplus, promoting clear organizational goals and working with the municipal and/or national governments receive support from less than one of five or ten respondents at the three hospital groups. By combining the three financial issues in the bottom row, we see that they also have a similar view on the importance of sound financial management. If we compare it with the first two items in the table, we can note that the staff at the three hospital groups derive a similar view of the main issues or challenges facing their hospitals. They perceive that providing good quality services, promoting good working conditions and maintaining sound financial management are the three most important issues. Moreover, the level of support for these three issues suggest that they also perceive the need to balance these three goals in similar fashion. The staff was also asked about a statement stemming from our interviews with the CEOs of these hospitals about the balance between patients and business. They could agree, neither agree nor disagree or disagree with
19 this statement. The staff at all three hospital groups provide quite similar answers, but there is a large proportion that chose the ‘Neither Yes or No’ alternative, making this question hard to interpret and somewhat unreliable. Q35: Patients 1st - Business 2nd *
Med Co-ops
Koseiren
Public
Dif. (h-l)**
Agree
50.6
45.6
44.7
6.1
*An unusually large proportion answered ‘Neither yes or no’, 40.3% respective 38.3% from the Medical Co-ops and Koseiren; **difference between high and low.
A plurality of them agreed with it, although two of five didn’t take a stand on this issue, and only one of ten actually disagreed with it. Similar to Question 26, the large proportion of ‘neither’ answers here seem to suggest a “don’t know” or “won’t answer” this question. The staff was also asked whether they participated in various activities or events related to their hospital’s community engagement. Q36: Participation in activity or event*/**
Med Co-ops
Koseiren
Public
Dif. (h-l)***
Hospital event (health festival. etc.)
61.1
53.3
27.4
33.7
Make investments or donations
72.2
15.3
5.6
66.6
Community activities (Han group, flea market)
48.7
21.2
8.2
40.5
Health activities and study groups
40.1
21.0
41.3
20.3
Volunteer activities (at festivals, newsletters, etc.)
29.8
14.6
9.7
20.1
Local co-op membership meetings
32.3
10.9
Na
21.3
*Indicates percent of positive answers, (often & sometimes); **there was much missing data, see the appendix for details; ***difference between high and low; Na=not available, this question/alternative was not available for staff at public hospitals, so the dif. only reflects the Medical Co-ops and Koseiren.
They only chose the alternatives that were relevant for their hospital group. Therefore, their answers vary considerably since each hospital group promotes quite different types of activities. Making investments of donation to the hospital is a good example. It is a practice at the Medical Co-ops, but not at the other two hospital groups. In fact, except for an annual hospital health festival, there is very little in common between these three hospital groups in terms of the type of “extra-curricular” activities their staff are engaged in. The notable differences between them seem to accentuate the differences in their profiles more than many other questions. In general, the staff at Medical Co-ops seems much more engaged in activities outside their respective hospitals. This is probably one of the variables where we find the greatest difference between the staff of the three hospital groups. Many of these differences reflect the difference in their settings, organizational styles, governance models and clientele. Finally, Question 33 provides room for respondents to provide their own comments about the social contribution of their workplace. These answers are not yet available in English.
G. Current health status The staff was asked several questions about their health status in relation to work and then in general. First was a question about work related burdens, physical strain or mental stress. Then came questions about their absence from work for physical or psycho-social reasons. Finally came a more general question about their current health status. Question 17 addresses work related health burdens, in the form of physical strain and/or psychosocial
20 stress. Here the negative answers are reported, since they clearly outweigh the positive ones. Q17: Physical & mental burdens at work*
Med Co-ops
Koseiren
Public
Dif. (h-l)**
Physical burdens or strain
30.9
35.5
42.7
11.8/P
Mental burdens or psychosocial stress
54.6
60.2
73.5
18.9/P
*indicates the percent of negative answers (rather much and much); **difference between high and low
Public hospital staff clearly bear the heaviest work burden, both in physical and psychological terms, and they show large differences with the two cooperative healthcare providers. The Medical Co-ops provide the least negative picture, relatively speaking. A notably larger proportion of the staff in all three hospital groups suffer from stress than from symptoms of physical strain at work. What are the consequences of such stress and strain factors at work? Question 29 addresses absenteeism due to stress and strain, as well as suffering from chronic pain. Q29: Absent from work because*
Med Co-ops
Koseiren
Public
Dif. (h-l)**
Can’t work due to mental stress***
4.7
2.8
2.5
2.2
Can’t work due to physical challenges***
4.2
3.1
2.0
2.2
Suffer from chronic pain from work
36.2
32.1
34.6
4.1
*Indicates percent answering (always), frequently or sometimes; **difference between high and low; *** excludes the ‘always’ alternative.
The staff was then asked about missing work due to mental stress, physical strain and/or suffering from chronic pain. Their answers are found in the table above. It is worth noting that Japanese health insurance does not pay ‘sick leave’. The ‘always’ answer was not relevant for mental or physical reasons, since it implied that they are no longer active in the workforce or not able to work. The differences between the physical and mental sources of work related problems is small and there are few differences between the staff working at different hospitals. Likewise, there is little difference between the staff at different hospitals in terms of having chronic pain. Nearly one–third of the staff at all three hospital groups complain of having chronic pain always, frequently or sometimes. Finally, the staff was asked to evaluate their personal health in general, in terms of being healthy, not so healthy and sickly, as seen in the table below. Q30: Estimate your current health*
Med Co-ops
Koseiren
Public
Dif. (h-l)**
63.4
65.6
62.1
3.5
Healthy
*Indicates only the proportion stating they are healthy; **difference between high and low.
More than three-fifths of the staff claim that they are healthy, while a third say they aren’t healthy. Once again, we note that there are very similar patterns, with only marginal differences between the staff at these three hospital groups in terms of their general health.
H. Staff’s personal background Finally, we asked the respondents about their personal background. This included questions about their voting behavior, gender, age, education, social status, family income and membership in other cooperatives. Note that
21 not all these background questions were included in the survey of public hospitals. Q38: Voting in national and local elections*
Med Co-ops
Koseiren
Public
Dif. (h-l)**
Always/usually vote in national elections
86.6
88.6
Na***
2.0
Always/usually vote in local elections
86.7
88.7
Na***
2.0
*Indicates percent of positive answers (always & usually); **difference between high and low: *** this question was not asked of staff at public hospitals.
In addition, respondents at both co-op hospitals indicate very high levels of voting in both the national and local elections. Q39: Gender
Med Co-ops
Koseiren
Public
Dif. (h-l)*
Male
20.0
24.5
17.6
6.9
Female
80.0
75.5
82.4
6.9/K
MD
2.5
2.0
*difference between high and low.
Respondents at all three hospitals show similar gender patterns, three-fourths or more of them are female. Q40a: Year of birth & Age*
Med Co-ops
Koseiren
Dif. (h-l)**
1996 to 1990, 22 to 29
8.8
18.1
9.3K/
1989 to 1980, 30 to 39
19.9
27.0
7.1/K
1979 to 1970, 40 to 49
30.5
24.2
6.3
1969 to 1960, 50 to 59
24.1
21.5
2.6
1959 to 1954, 60 to 64
7.8
6.8
1.0
1953 to 1941, 65 and up
9.0
2.5
6.5
*this question was not asked of staff at public hospitals; **difference between high and low.
Respondents at the Medical Co-ops have a somewhat older profile than their colleagues at the Koseiren hospitals. Turning to their highest education level attained, we note similar levels of attainment in both hospital groups. Staff at the Medical Co-ops claim higher rates of Jr. High education than their colleagues at Koseiren hospitals, and lower rates of education at vocational colleges. They also note lower rates of completing a university degree and/or graduate school. This probably reflects differences in educational and training opportunities in different parts of Japan. Q41: Education
Med Co-ops
Koseiren
Public
Dif, (h-l)*
Jr. High & High School
22.0
12.4
8.1
13.9
Vocational Sch/College
36.6
45.1
39.0
8.5/K
Jr. College
14.9
11.7
15.2
3.5/P
University & grad school
26.5
30.7
37.7
11.2/P
MD
3.4
2.5
22 *difference between high and low.
Concerning their social status, once again we note similar patterns among respondents from both hospital groups. There are only modest differences between these two hospital groups. Q42: Social status*
Med Co-ops
Koseiren
Dif. (h-l)**
Single
14.2
19.7
5.5/K
Couple
13.6
11.0
2.6
Couple w children
45.7
41.5
4.2
Single parent family
9.6
7.9
1.7
3 gen. family or more/ other alts
13.8
17.0
3.2/K
MD
3.1
2.8
0.3
*this question was not asked of the staff at public hospitals; **difference between high and low.
Concerning their household income, we can note similar patterns among both hospital groups. However, there are more families with more than 10 million Yen among Koseiren staff than the Medical Co-ops. Q43: Household income*
Med Co-ops
Koseiren
Dif. (h-l)*
Less than 2 mil. Yen
9.9
6.1
3.8
Between 2 and 4 mil. Yen
27.9
24.6
3.3
Between 4 and 6 mil. Yen
25.0
23.3
1.7
Between 6 and 8 mil. Yen
15.4
16.0
0.6/K
Between 8 and 10 mil. Yen
9.0
11.6
2.6/K
More than 10 mil. Yen
7.9
18.7
10.8/K
MD
5.1
5.2
0.1
*staff at public hospitals was not asked this question; **difference between high and low.
Finally, concerning membership in cooperative organizations, there is a clear pattern of very little overlapping membership. This table reports the largest differences between these two hospital groups of any included in this presentation. However, these differences are completely logical and fully understandable. More than nine-tenths of the Medical Co-op staff belong to health and medical co-ops and a third of them also belong to a consumer co-op, while less than one in ten also is a JA member. By contrast, nearly three-fourths of Koseiren staff belong to a JA affiliate, and less than one-fifth of them belong to a consumer co-op, while very few claim membership in a health co-op. Q44: Member of other co-op*/**
Med Co-ops
Koseiren
Dif. (h-l)***
Health co-op
92.1
2.2
89.9
Consumer co-op
33.3
18.1
15.3
JA (full & family memb.)
8.3
71.9
63.6/K
Other co-op, specify…
0.5
1.4
0.9/K
23 MD
4.8
20.3
15.5/K
*Indicates the proportion of positive responses; **staff at public hospitals was not asked this question; ***difference between high and low.
Appendix: Table A. Missing data for special questions MD
9.6
9.8
21.1
21.2
21.3
21.4
21.5
21.6
21.7
K
23.9
11.9
22.5
40.9
54.7
46.1
53.2
60.5
95.6
MC
25.4
11.0
9.7
23.7
38.4
31.5
32.7
49.5
96.2
Neither*
26.1
26.2
26.3
Q35*
MD
31.1 to 31.10
K
45.9
33.1
49.0
40.3
K
13.8
MC
44.4
42.5
48.0
38.3
MC
9.5
*Neither agree nor disagree.
MD
36.1
36.2
36.3
36.4
36.5
36.6
36.7
K
6.6
16.7
19.0
12.3
14.3
18.7
91.4
MC
7.8
9.9
8.9
8.4
10.3
6.9
95.1
24 Table B. Reliability scaling for work life indices and cutting points for H, M & L variables Index
variables
Cronbach’s Alpha
Cut points for 3 parts
% high
% med.
% low
1.25/2.20
30.7
40.3
29.0
Instr. Values
9.3, 9.4, 9.5, 9.8
Soc. Values
8.2, 9.2 & 9.7
.824
Work Satisfaction.
10.3, 11.1, 11.2, 11.3, 11.4, 11.5
.877
2.00/2.83
31.8
34.3
33.9
Work Demands
12.1, 12.2, 12.3, 12.4 & 17.1, 17.2
.748
2.67/3.50
34.8
30.6
31.5
Soc. Sup.
13.1, 13.2, 13.3, 13.4
.833
2.00/3.25
33.0
35.9
31.1
Control
14.1, 14.2, 14.3, 14.4
.855
2.50/3.33
34.0
31.5
34.5
Influence
15.1, 15.2, 15.3
.912
2.00/3.33
34.4
39.7
25.9
Pers Dev.
16.1, 16.2, 16.3
.758
2.33/3.33
39.7
32.4
27.9
Wk/life bal.
18.2.1, 18.2.2
.811
2.00/3.50
33.3
39.5
27.2
Networking
20.1, 20.2, 20.5
.636
2.33/3.33
26.4
36.1
37.5
Serv. Qual.
23 & 27
.706
1/3
46.2
---
53.8
Pats Rights & Info.
24.1, 24., 24.3 & 25.1, 25.2, 25.3, 25.4
.880
1.71/2.14
33.4
32.6
34.0
Staff data, overview 219.
