Recently, the concept of resilience engineering has often been introduced in the field of patient safety in Japan. Although the word “resilience” cannot be translated exactly into simple Japanese, the Japanese can consider the original Japanese way of education, which fostered resilience in reality. This study surveys how the Shonai clan, the Aizu clan, and the Nagaoka clan had provided education in their academies in the last years of Edo-era and how they battled resiliently in the Boshin war, and deduces the way of education to foster resilience of organization. In their academies, the clans had made elaborate efforts to cultivate humanity in students mainly by Confucianism and additionally through history, thought, and literature. They had arranged reward systems. The Shonai clan and the Aizu clan had let students move up to the next grade according to only their ability. The Shonai clan and the Nagaoka clan had not let only teachers but also clan executives examine students. The Shonai clan, influenced by the Sorai school, had especially respected the individual’s personality, promoted self-study, and adopted the Socratic method. The Aizu clan had let students shape their character and establish human relationships under discipline from the viewpoint of the Zhu-zi school, and never condoned underachievers. The Nagaoka clan had adopted a voluntary entrance system for their academy, supported extracurricular activities, and tolerated various schools. Tsuginosuke Kawai who was its governor-general at the time of the Boshin war had studied the extracurricular activities at the Yang-ming school and furthermore had studied abroad after graduation. Through the war, the Shonai clan could devise many creative and reasonable tactics, so it was extremely strong in close battles. The Aizu clan could stand together as one and heighten their spiritual strength, so it could endure and keep combatting over the long term. Under Kawai’s leadership, the Nagaoka clan resolutely opposed the new government's unfairness and unrighteousness, cooperated brilliantly with allied forces, used creative and tenacious tactics, and achieved the recovery of the Nagaoka castle. The three clans maintained a high level of military discipline and fought outstandingly well even though they were designated as rebels by the nation and had a serious shortage of personnel and materials. To foster the resilience of organizations, moral and ethical education and reinforcement of spiritual strength; meritocratic education specialized toward development of creativity, adaptability, and practicality; and education that emphasizes fundamentals are essential.

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Background: Complaints related to health care made by patients and their families to medical institutions may pose a serious risk not only to the patient's life and health, but also to hospital organizations. In 2014, Reader et al. established a patient complaint taxonomy through a systematic review, which finally opened the way for future utilization. In this study, we created our Japanese version of this taxonomy, verified its usability, and statistically analyzed the tendencies of complaints.
Methods: We developed a Japanese version of Reader et al.’s taxonomy and utilized this to classify complaints and other thoughts collected via Patient Services at Tokyo Medical University Hospital between January 2019 and June 2021. We examined the trends in complaint categories according to medical specialty in addition to those that did not specify a medical specialty.
Results: The Japanese taxonomy can be used to analyze patients’complaints and thoughts in large teaching hospitals in Japan. Because of the wide range of complaints addressed in this study, it can be used in other hospitals in Japan as well. This study suggests that the trends in hospital complaints in our country may differ from those in previous studies conducted in other countries. Complaints that did not fall under a specific category included words of gratitude, negative views on certain matters, unintelligible words, and clear accusations.
Conclusion: This Japanese taxonomy can be used to analyze complaints in Japan, and the knowledge gained from its use will contribute not only to the handling of complaints at individual hospitals, but also in improving the quality of facilities throughout Japan.

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Purpose: We have experienced the case in which an attending physician reported an expected death to the police as an unnatural death. In this case, we reconsidered the significance of unnatural deaths occurring in hospital settings and of reporting them to the police, under the operation of the nation’s medical accident investigation system.
Summary of the case: A male patient in his 60s was admitted to our hospital. The patient’s condition stabilized in intensive care. However, on the 35th day of hospitalization, he suddenly bled from the tracheotomy and died of hemorrhagic shock on the same day. The attending physician had previously reported emergency outpatient deaths of unknown causes to the police as unnatural deaths and requested inquests. Accordingly, he reported this death to the police as unnatural, meaning the cause of death was unknown. The police came to the hospital and investigated this case based on the hypothesis that medical malpractice was involved. The police cancelled the scheduled pathological dissection at our hospital and conducted an autopsy based on investigative legislation regarding the cause of death and the person’s identity （a new legal autopsy）. When we asked the police for the results of the autopsy, they refused our requests. After inquiring several times, we finally received the response that “the death was caused by heart failure” , and there was “no obvious bleeding in the trachea” . Then the police investigation was closed, and the cause of bleeding remained unknown. We reconsidered the significance of reporting unnatural deaths to the police, from the perspective of death investigation.
Conclusion: Based on this case, in the viewpoint of the solution of healthcare problems, we could not identify the significance of reporting unnatural deaths, including medical-related deaths, to the police for the criminal investigation, which was defined by the “Guidelines for Notification of Unnatural Deaths”, under the nation’s medical accident investigation system in which appropriate investigation and analysis were performed by medical professional.

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From 2018, in order to share a patient’s risk factor for postoperative complications, doctors are required to include a “postoperative care plan” template to their patients’ electronic medical records. This was set as one of the “safety priority items” to be addressed by the entire hospital, and the effect of this template was monitored both quantitatively and qualitatively. From 2018-2019, Patient Safety Management Section aimed to inform the hospital staff on ways to improve the quality of postsurgical care plans. We were able to confirm, through both quantitative and qualitative measures, that they were successful in their efforts.
The awareness of rules （quantitative measurement） was improved through general activities such as in-hospital meetings and effective email distribution. However, rule compliance （qualitative measurement） was improved through not only increased awareness of the rules, but through the creation of a better system and by staff taking initiative.

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In the current COVID-19 pandemic, the emergency department is required not only to perform usual services but also to accept patients with severe COVID-19. The first priority is to prevent nosocomial infections, and the second is to undertake containment measures promptly in the event of a positive patient entering the hospital.
At the study institution, full personal protective equipment for medical staff is now mandated in all initial medical care to minimize accidental exposure. Patients are admitted, not rely only based on their PCR test results, but also on any symptoms and an assessment of their risk of having a SARS-CoV-2 infection. At the same time, the emergency ward was reconfigured by increasing the number of negative pressure and semi-independent rooms, which facilitated the implementation of these measures.

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Outpatient clinic is the contact point of medical institutions. Since there are many patients receiving medical examinations, there is a risk becoming a route for transmission of SARS-CoV-2 infection, which is one of the important points of infection prevention. SARS-CoV-2 is characterized by the several points, 1. transmission via aerosol in addition to via droplets, 2. the virus spreads from a few days before the onset of the disease, and 3. the virus long survival time in the environment. It is necessary to take countermeasures while paying attention to the above points. In this paper, I described the standard precaution for the outpatient clinic, and special countermeasure such as telemedicine for the outpatients with hypertension, or diabetes mellitus without visiting a medical institution by making full use of communication via the Internet, and self-monitoring equipment for blood pressure or blood glucose.

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[in Japanese]

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[in Japanese]

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The new coronavirus infection （COVID-19）, reportedly first detected in Wuhan, People’s Republic of China in December 2019, was also first reported in our country in January 2020. As the infection has been spreading since then, our hospital has been holding daily meetings on countermeasures against the new coronavirus infection since April 7 of the same year, and has been repeating trial and error every day. In this paper, we will introduce the efforts of our hospital, a university-affiliated psychiatric hospital, to deal with mental health problems caused by the coronavirus. For the patients, we have taken measures such as exercise to reduce stress in a closed space. For the staff, we have actively encouraged them to participate in the Medical Support Project, and we have conducted mental health checks using self-administered rating scales. As a result, we seem to have achieved a certain level of success in our efforts for the patients, but our efforts for the staff have lagged behind and are still on the way. We believe that it is necessary to strengthen mental health measures for staff as soon as possible.

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[in Japanese]

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