Changes in University Hospital Physicians’ Work and Family Lives Following Outsourcing of Housework Cleaning Tasks

ABSTRACT

Background

Japan is reviewing how physicians operate and plans to implement a work-style reform for physicians in 2024. This study examined how outsourcing housework cleaning tasks changed the daily lives of university hospital physicians.

Methods

A total of 18 physicians participated in the study, outsourcing cleaning tasks either once or thrice.

Results

Fourteen out of 18 respondents reported a decrease in the burden of household chores. Additionally, 10 respondents reported having more time for family contact, and nine respondents reported having more time for their own hobbies and diversions. Meanwhile, only five respondents reported that they had more time to work.

Conclusion

Outsourcing housework cleaning tasks and using the newly created time for family and self may improve work performance.

Japan’s medical care system is supported by the long working hours of physicians.¹ The work-style reform for physicians to be implemented in 2024 aims to overcome this situation by reducing the workloads by promoting appropriate human resource management and task shifting.¹ However, reducing physicians’ workloads is challenging because of their responsibility for handling human life.

The high workloads of physicians have been shown to adversely affect their family lives²; as the burden on their families increases, the negative impact of their poor work-life balance (WLB) also increases.^{3, 4} As such, organizational efforts to promote WLB that accommodate family roles may improve work engagement.⁵ Therefore, we hypothesized that reducing the burden of physicians’ family roles, but not their work roles, might better facilitate their WLB.

One way to reduce the burden of housework is through outsourcing,⁶ which involves the use of household chore support services (HCSS). HCSS is “a service in which a business’ staff visits a user’s home and performs all or part of household chore-related tasks (cleaning, laundry, cooking, etc.) mainly at the user’s home on behalf of the user.”⁷ Fukuzaki et al.⁸ surveyed physicians about their past experience using HCSS. They found that physicians were more likely than the general workforce to have outsourced housework in the past and that this may be an effective way for busy physicians to reduce their family role burden.⁸

Therefore, this study focused on university hospital physicians, who are more likely than other physicians to experience difficulties balancing work and family lives.⁹ We then investigated the kind of changes that occurred in work and family life by using cleaning of HCSS.

SUBJECTS AND METHODS

The study recruited physicians at local university hospitals who wished to outsource their housework to the HCSS. HCSS send employees to the client’s home to perform general household tasks such as cleaning, laundry, and cooking.⁶ The service providers used in this study were three companies available near the university hospital where the participants were recruited, and the participants were allowed to choose which company to use. The study limited the services to cleaning only, which would not be affected by the physicians’ level of need or household differences.⁸ Staff providing HCSS visited their home and provided cleaning services for two hours per visit. Participants were recruited under two plans—one-time only or a total of three times (one vs. three times per month). Each visit cost 16,500 yen, and three visits cost 49,500 yen. However, the service fee was included in the project expenses for this study; hence, there was no financial burden on the participants. Participants were surveyed via a Google form within three days of their last service use.

The recruitment period was from September to November 2022. A total of 18 physicians (12 men and 6 women) participated in the study. Participants were excluded if they had continuously received HCSS for more than three months when they applied to participate in the study. The participants used the services between September 2022 and February 2023. Eight participants used the one-off plan while 10 used the monthly three-visit plan. Three vendors (I-III) were used, with 3 physicians for I, 8 for II, and 7 for III. Among the physicians who participated in the study, 15 cohabited, while 3 lived alone.

The survey consisted of two parts: A) Changes in life because of using the service, and B) thoughts about use of the service. Part A consisted of four questions created for this study: “I feel less burdened by housework,” “I have more time to spend with my family (children, partner, etc.),” “I have more time for myself, such as enjoying hobbies and relaxing,” and “I have more time to work.” Responses were measured on a five-point Likert scale ranging from “strongly agree” to “strongly disagree.” Part B used an open-ended format.

For statistical analysis, a chi-square test was performed on the responses to the four questions in Part A to determine whether there were differences by gender, cohabitation with others, service provider, and frequency of service use.

This study was approved by the Ethics Review Committee of the Faculty of Medicine, Tottori University (No. 23A011).

RESULTS

Basic information of the study participants and survey results are shown in Table 1.

Table 1.  Basic information of the participants and the findings.

Basic Information						A) Changes in life because of the serviced				B) Thoughts on the servicee
No	Age	Gendera	Cohabitant(s)b	Service provider	Frequency of service usec	“I feel less burdened by housework”	“I have more time to spend with my family (children, partner, etc.)”	“I have more time for myself, such as enjoying hobbies and relaxing”	“I have more time to work”
1	30s	W	+	II	1	+	±	–	–	“Glad the house is clean. I had no weekday off and left early for service, but I was working until the last minute.”
2	30s	M	+	III	3	+	+	+	+	“We are very grateful for this service. I would like to use it again in the future.”
3	40s	M	+	III	3	±	+	+	±	“They cleaned up very well.”
4	40s	M	+	II	3	±	±	±	±	“I was grateful.”
5	40s	M	+	II	3	+	±	–	±	“My wife was very pleased.”
6	40s	M	–	III	1	+	+	+	+	“As an unaccompanied assignment, I have to do all the housework myself, but I am often too busy with work to get it done. This housekeeping support service was very helpful because it focused on areas that I tend to put off. I felt like I could do my best at work when my house is in order. I would definitely like to see the housework support service continue.”
7	30s	W	+	I	1	+	+	+	+	“First time using it and it was great. Would be nice if it were less expensive.”
8	40s	M	+	II	3	+	+	+	±	“It was very helpful. It would also be nice to be able to show our appreciation if we could do our own house or our parents’ house. It would also be nice to have a child care service for the whole day off to give the couple some time together.”
9	40s	M	+	I	1	+	–	+	+	“I felt so much better after having the cleaning done, which I thought I had to do for a long time. In the meantime, I was able to do other things that needed to be done in the house, and it was a very worthwhile two hours. I’m glad I didn’t have to worry about asking for help because the fee was light.”
10	30s	M	+	II	3	±	–	–	–	“It was helpful.”
11	40s	W	+	III	1	+	+	–	–	“The service is helpful because they can concentrate on household chores that they are not able to do on a daily basis. My holidays are irregular, so it is difficult for me to use the service on a regular basis. One-time use of the service would be helpful.”
12	Under 30	W	+	III	1	+	±	+	±	“I am not able to spend much time on cleaning, so I was grateful to have the place cleaned. The price was very expensive and only one area needed to be cleaned in 2 h, so I thought it would be better to have them clean only once or twice a year. If I were to ask them once a month, I felt that it would be better to have them do a little more work on various areas rather than just one area thoroughly, so that I would not have to worry about my regular cleaning.”
13	30s	M	+	II	3	+	+	+	+	“The housework burden was removed and the house was cleaned, so I could feel refreshed.”
14	30s	M	–	III	3	+	+	±	±	“I wanted to use the service on a regular basis because of the cleaning of areas that are usually inaccessible.”
15	40s	W	–	II	3	+	+	+	–	“I would like to request this service on a regular basis.”
16	30s	M	+	I	1	+	+	–	–	“My spouse was satisfied.”
17	30s	M	+	III	1	–	–	–	–	“Unable to have a family member alone in their home, making us busy and unavailable.”
18	40s	W	+	II	3	+	–	–	–	“It was cleaned up and very helpful. However, I don’t feel it is very significant because I have to sacrifice my work to be detained for 2 h on weekdays.”

^aM: man, W: woman. ^b+: yes, –: no. ^c1: one, 3: three times per month. ^d+: "strongly agree" or "somewhat agree," ±: "neither agree nor disagree," –: "somewhat disagree" or "strongly disagree." ^eopen-ended format.

Regarding the item, “I feel less burdened by housework,” 14 out of 18 respondents answered “strongly agree” or “somewhat agree.” For the item, “I have more time to spend with my family (children, partner, etc.),” 10 respondents answered “strongly agree” or “somewhat agree.” In addition, nine respondents answered “strongly agree” or “somewhat agree” to the item, “I have more time for myself, such as enjoying hobbies and relaxing.” On the other hand, for the item “I have more time to work,” only five out of 18 respondents answered “strongly agree” or “somewhat agree.”

A chi-square test was performed on the responses to the four questions in Part A to determine whether there were differences by gender, cohabitation with others, service provider, and frequency of service use. The results showed no significant differences in all cases (all n.s.).

For thoughts about use of the service, several respondents stated that they were happy to have a clean house as they had been unable to clean because of their busy work schedules. While some physicians wanted to use the service regularly, others preferred to use it on a one-time basis because of irregular days off. Some male physicians commented that their spouses were pleased with the cleanliness of their homes. Meanwhile, negative feedback arose from safety concerns, as user or cohabitant had to be at home when using the service, which limited their time. Additionally, although the participants were not charged any costs in this study, they provided input regarding the price of the service.

DISCUSSION

Outsourcing housework has been shown to reduce the burden of housework.¹⁰ In this study, 14 out of 18 respondents reported a decrease in the sense of burden from household chores. Therefore, outsourcing of housework cleaning tasks could decrease housework burden among physicians working at university hospitals in Japan. Ten of the 18 participants reported that they had more time to interact with their families, and nine reported that they had more time to spend on their hobbies and diversions. Outsourcing housework and using the free time for leisure has been shown to improve family happiness.^{11, 12} In addition, effective stress coping has been shown to reduce stress reactions and improve job performance in workers.¹³ Therefore, when physicians outsource housework and use their free time on their families and themselves, it can energize them and indirectly improve their work performance. In other words, it benefits both physicians and hospital organizations.

Meanwhile, only five participants reported having more time to work. This means that fewer physicians used the time made available by outsourcing housework cleaning tasks. Fukuzaki et al.⁸ reported that a higher percentage of female physicians outsourced household chores to have more time for work than male physicians. This difference in results may be due to the small number of participants and differences in their background information.

This study has three limitations. First, this study only analyzed participants’ feedback on outsourcing their cleaning tasks. Additionally, the outsourcing frequency was low, occurring either once or thrice. Therefore, future research should consider outsourcing housework cleaning tasks more frequently and examine the effects of interventions in detail using psychological scales with tested reliability and validity. Second, the participants in this study received free cleaning services. Hence, they may have evaluated the efforts of the organization positively to sustain this initiative. In other words, the survey results may contain response bias. Third, this study did not measure basic attributes in detail, and therefore lacked analysis from those perspectives. For instance, the effect of outsourcing housework cleaning tasks may vary in cases where one lives with preschool children or someone requiring care. Finally, this study used different service providers. Although the analysis results showed no differences among service providers, it would be desirable to standardize the interventions to verify their effectiveness. Future intervention studies should take these issues into account.