Impact of ‘Toyota model’ in healthcare sector

A recent study by Stockholm University assesses the correlation between shorter working hours and improvements in health, well-being and the level of physiological stress among workers in the healthcare sector. The study evaluates the effect of introducing a new working time model, the so-called ‘Toyota model’, and its effect on employee health and work satisfaction. It concludes that the new working time model has no significant effect on workers’ health or stress levels.

About the study

A study by Stockholm University (Stockholms universitet) examines the relationship between shorter working time and improved health among workers. Psychologist Ulrika von Thiele assesses the situation of about 130 employees working in the healthcare sector for 18 months to determine if the use of the so-called ‘Toyota model’ improves the employees’ health, well-being and stress reactions. The Toyota model combines a decrease in total working time with an increase in the number of shifts, and also sets aside additional time for vocational training, education and exercise. The weekly working time for the workers involved in the study was reduced to 33 hours, of which three hours were allocated for vocational training, further education and exercise.

Methodology

The study involved the completion of a health check and a questionnaire on three different occasions by each employee. Some 88 of the employees involved in the study work in three workplaces that introduced the Toyota model. A further 29 employees in workplaces that did not change their working time model acted as a control group to determine if the Toyota model had a significant effect on health, well-being and physiological stress.

Main findings

The majority of healthcare workers in Sweden work directly for municipalities and country councils. Municipal authorities have in recent years been characterised by the implementation of budget cuts, an ageing workforce and a high rate of absenteeism among employees. The Toyota model was introduced to allow older employees to continue working until the retirement age of 67 years, and to attract and retain younger employees.

Toyota model leads to positive and negative effects

The main findings of the study involving 130 workers in the healthcare sector indicate that the introduction of the Toyota model does not have a significant effect on employees’ health, well-being or work satisfaction. The study focused on perceived health and psychosocial factors, the effects on physical health, and also on access to learning and education among employees. Only a few small positive effects were found. Such effects included a lower waist-hip ratio, which is used as an indicator of a person’s health and measures the risk of contracting cardiovascular diseases. A lower stress level among workers at one of the three workplaces studied was also found. On the other hand, employees at one workplace experienced a decline in work satisfaction, increased job demands and a decrease in the possibility for support. However, these effects do not apply to the whole population sample of the study. In most areas, no changes were found, either over time or in comparison with the control group.

The Toyota model allows employees additional time for vocational training and education, but the study shows no significant effects on perceived learning at work among the employees participating in the study. In only one area, ‘time to keep updated’, the Toyota group showed an improvement compared with the control group. In the other areas, there was a negative change over time.

No significant improvement in relation to health, well-being and stress levels

The study concludes that the Toyota model did not significantly improve employee health, well-being, stress levels or work satisfaction when introduced in the healthcare sector. The introduction of this new working time model only had a small effect, negative or positive, and in many areas there was no significant effect at all. These results apply both when looking at the situation over a period of time and in comparison with the control group. The authors of the study conclude that the introduction of the Toyota model is not justified in the healthcare sector due to the high costs involved in its implementation and the small improvements stemming from it. For instance, there might also be other measures that can be introduced that will lead to larger improvements in employee health, such as investments in the organisation or the working environment. The authors also add that the control group proved to be unsatisfactory for the purpose of comparison, due to differences between the two groups in terms of the values of the examined variables at the outset of the study, as well as the large decline in the number of participants in the control group.

Commentary

Although the introduction of the Toyota model did not produce the sought after results, drawing conclusions from this study only may be premature. This study looked at the employees’ health and working experience, and it showed no significant positive effects. However, it did not show any significant negative effects either. It is possible that the introduction of the Toyota model in the healthcare sector would improve other aspects of the work organisation, for example economic efficiency or the experiences of patients receiving care. In either of those cases, introducing the Toyota model may be justified. Other studies have shown that the Toyota model improves efficiency in the healthcare sector, and that it leads to better patient care (see Lövtrup, 2008).

Furthermore, several problems can be identified with the method used to evaluate the model. The control group proves to be unsatisfactory as a comparison, and factors other than the introduction of the Toyota model affected the results at all three workplaces. A change in routines was perceived to be negative by the employees and may have had an effect on their work situation and thus on the results of the study. The difference between the study and the control groups makes it difficult to draw generally valid conclusions from this survey.

References

Lövtrup, M., Modell från bilindustrin ska rädda sjukvården (594Kb PDF) [Model from the car industry shall save healthcare], Läkartidningen, Vol. 105, No. 47, 2008.

von Thiele, U., Lindfors, P. and Lundberg, U., [Toyota-modellen – en arbetstidsmodell i tiden? (628Kb PDF)](http://www.previa.se/upload/Forskning & artiklar/Rapportutv0605.pdf) [The Toyota model – a concurrent working time model?], AB Previa and Department of Psychology, Stockholm University, 2006.

Mats Kullander and Claes Bäckman, Oxford Research