Organizational structure, worker participation, and health: a cross-sectional survey study among Japanese hospital...

Worker participation, reflecting perceptions of control and influence in one's work environment, is known to buffer job stress and promote employee wellbeing, but opportunities for participation are influenced by organizational dynamics. In Japan, hospitals operate under various organizational structures characterized by distinct governance, culture, and values. How these structural differences shape worker participation and, ultimately, health remains unclear. The purpose of this study was to explore how organizational structure influences worker participation and the subsequent impact on perceived health among Japanese hospital employees.

Cross-sectional survey data were collected from 6,859 employees across 10 hospitals representing three organizational structures: Japanese Health and Welfare Co-operative Federation, Japan Agricultural Cooperatives Welfare Union, and public hospitals. Worker participation was measured using two indices: (1) discretion over work, and (2) opportunities to express opinions. Self-rated health was assessed using a single item. Kruskal-Wallis tests were used to compare worker participation scores across organizational structures and self-health ratings. Then, ordinal logistic regression was used to estimate the odds of better self-rated health per unit increase in participation index scores. Finally, multilevel modeling was used to analyze the association between health and participation, adjusting for demographic and work-related covariates and accounting for clustering by organizational structure.

Worker participation scores varied significantly by organizational structure; they were highest in the more cooperative structures and lowest in the more hierarchical public structure. Each one-point increase in Index 1 and Index 2 scores was associated with 38% (OR = 1.38, 95% CI = 1.28-1.49, p < 0.001) and 49% (OR = 1.49, 95% CI = 1.39-1.60, p < 0.001) higher odds of better self-rated health, respectively. Notably, the positive association between worker participation and health was largely consistent across organizational structures, with organizational structure contributing minimally (ICC = 0.004, 95% CI = 0.001-0.027) to self-rated health beyond worker participation.

Organizational structure shapes worker participation, which in turn positively predicts self‑rated health among Japanese hospital employees. Policies and practices that foster participatory work environments, including enhancing employee discretion and voice, offer a practical and scalable approach to improving healthcare workforce wellbeing across varied settings.