In addition to a shortage of pediatrics, obstetrics and gynecologist, recently, the shortage of surgeons has become an urgent and serious problem as well. However, only a few quantitative studies researching this problem have been conducted to date. This paper investigates the surgeon shortage problem, including an estimation of future demand using official government statistics. Presently, the real number of surgeons has been decreasing in Japan, and the decrease of male surgeons is especially severe. On the other hand, the demand for surgeons is increasing with the aging population. However, it is estimated that the increase of demand will peak out around 2020. As a solution to the surgeon shortage problems we therefore conclude that an improvement of the working environment and a reconstruction of the medical system would be recommended rather than an increase in the total number of surgeons, which would take too long to train.

This study examines the behavioral characteristics of nurses administering oral medications. We presented questionnaires consisting of 66 items to 3,319 nurses working in general wards at 56 hospitals in Japan and received valid responses from 1,638 of them.

We performed factor analysis with evaluation scores of the 37 items for which evaluation scores of the no-error group were significantly higher than those of the error group. As a result, we identified three factors：“information utilization,” “cooperation,” and “operational coordination and knowledge acquisition." We compared factor scores of nurses by analysis of variance. Independent variables were frequency of medication error and years of experience. The scores of the group with three or more errors were significantly lower than those of other groups with regard to “information utilization” and “operation coordination and knowledge acquisition.” This suggests that nurses making fewer medication errors use information about patient status and drugs more positively, adjust safe operations during administration more consciously, and acquire the latest information about knowledge and skills for safety more completely. “Cooperation” scores of mid-career nurses were significantly higher than those of short- and long-career nurses in the group with three or more errors. This suggests that short-and long-career nurses make medication errors because they don't actively cooperate with other staff members, while mid-career nurses make medication errors in spite of cooperating with others.

In rural areas of Japan, the elderly make up a high percentage of the population. On top of this, the uneven distribution of health care workers in the nation greatly favors urban areas. As a result of these two factors, the medical care system faces serious problems.

To improve health care in regions outside of the large urban centers, we must overcome three strategic challenges. First, the regional medical center has to be transformed into a magnet hospital that can attract and educate medical staff. There is a need to foster generalists (medical staff associated with non-specialist, general medicine) who have a wide clinical viewpoint. Also, it is necessary to develop a pleasant work environment that includes day-care facilities for hospital staff and job-placement assistance for female staff. Second, attention must be given to the creation of local support for community medicine. A local medical culture must be fostered, one that, for example, phases out so-called convenience visits to emergency wards. And third, in order to provide high quality care in community medicine, team health care and medical networks should be promoted. Medical institutions in the region would work together as a team, with each member's role outlined in the procedures of liaison critical pathways. As medical quality is standardized and medical transparency achieved, patient-oriented medicine in the region will become a reality.

This paper introduces the practice of health care management at Fukuchiyama City Hospital.

In order to examine the current situation of patient education on prevention of recurrence of myocardial infarction, a questionnaire was administered to 157 hospitals and 395 clinics in Hiroshima Prefecture and Osaka Prefecture Toyono Medical area by mail, between January and March, 2010. Thirty-one valid forms were received from the hospitals (valid response rate, 19.7%) and 168 from the clinics (42.5%).

Community collaboration critical pathways were used in 16.1% of the hospitals and 14.3% of the clinics. Patient education was practiced in 74.2% of the hospital wards and 61.3% of the outpatient units, and 59.5% of the clinics. Specialists were allocated more at the hospitals than at the clinics. The patient education at the hospitals included dietary education by dietitians, medicine intake guidance by pharmacists, and diabetic management education by nurses. Education at the clinics was largely done by physicians, and the average time spent was 5 to 10 minutes at one session.

Due to short length of hospital stay and that patients are quickly discharged to clinics, patients at the acute stage could not afford time to receive education. The clinics had few specialists allocated and education was limited to short sessions by physicians during the consultation. Based on these facts, we strongly suggest to develop, foremost, community collaboration critical pathways between hospitals and clinics which promote collaborative patient education aimed at prevention of recurrence and aggravation. The pathway should then include outcome indicators to further develop a new preventive system supported by a medical insurance organization and/or a disease management company.

“The perioperative management guideline of antithrombotic drugs” was created for the purpose of attaining standardization of discontinuation, perioperative care, and resumption of an antithrombotic drug in the hospi-tal. In order to attain standardization, 1) clarification of the roles of the many occupational descriptions by the guideline, and 2) improvement of the hospital information system for inter-professional information sharing, were implemented.

The guideline is constituted as follows：(1)The guideline for standardizing inter-professional correspondence, such as a department of treatment, prescription, pharmacy, and nursing. (2)The model of consent document regarding discontinuation of an antithrombotic drug by department. (3)The guideline of the emergency operation for patients taking anti-coagulants. (4)A risk description of post-discontinuation of the antithrombotic drug for Prescription Department. The current hospital information system (electronic charts and electronic critical path) was utilized to attain inter-professional information-sharing.

Now, practical use of the guideline is smooth and is considered to be useful in obtaining patient safety. However, for reduction of the risk of the thrombotic events, both treating doctors and prescribing physicians must analyze each patient's conditions carefully, and treatment plan should follow detailed discussions with the patients regarding the necessity of discontinuation of the antithrombotic drugs and the risks that may follow.

Ｔhe speed-up of the clinical trial is an important issue. We, therefore, have searched the factors which influence the lead time percentage using the protocol data of the clinical trials in the past. Multi-regression analyses were performed for 18 phaseIII clinical trials of the adult patient subjects which were conducted during 5 years from 2003 until 2007. As a result, the regression equation was induced with parameters of 5 influencing factor；the lead time percentage(%) = 1.80A −1.23 B−2.16 C−0.08 D＋ E + 68.56 (A；number of inclusion criteria, B；number of exclusion criteria, C；number of laboratory tests, D；study duration(day), E；investigational product(internal/external medicine：5.45, injection：−5.45 ),Ｐ=.0005､ R^２=0.81､ RMSE=8.8). By substituting the data of these 5 factors for the regression equation, the lead time percentage of the concerned clinical trial would be estimated at the time of the contract, resulting in the qualitative improvement of the clinical trial management.

In April 2008, nine hospitals of National Hospital Organization in Kyushu area increased pharmacists. Two of them instituted pharmacists regularly stationed at wards. Thus, we reviewed the transition of pharmaceutical management numbers as indication of economic effect, and reviewed the transition of patient-brought-drug examinations and the PRE-AVOID reports as indication of quality. First we compared the numbers of pre-and post-stationing of pharmacists in wards and reviewed comparison with the hospital which did not regularly station pharmacists in wards. Two hospitals with pharmacists stationed at wards successfully improved the number of pharmaceutical managements and examinations of drugs brought by inpatients compared to prior to March, 2008. The number of PRE-AVOID reports increased greatly at the one hospital. In the hospital where pharmacists did not stay at ward, the number of pharmaceutical managements and the germfree disposal showed no considerable increase/decrease tendencies, and there were little PRE-AVOID reports. The findings of the present study suggest stationing pharmacists at wards has significant effect to enhance both the number of pharmaceutical managements and the qualitative effect of drug uses.

　A survey research was conducted to define the factors affecting the organization effectiveness of a pharmacy. To this end, the attitudes toward the organization and jobs of pharmacists and administrative staff members working for a community pharmacy were studied to explore factor configurations and correlations among these factors.

　Copies of a self-administered questionnaire were distributed to all pharmacists and administrative staff members working for a pharmacy that has deployed stores mainly in the Kansai region. Factor analysis was performed using responses from 409 pharmacy employees (257 pharmacists and 152 administrative staff members) on 27 questions regarding their attitudes toward the organization and jobs. Then simultaneous analysis of multiple populations was performed using structural equation modeling to validate the correlations among factors, and the results were compared between the jobs.

　As a result of the factor analysis, five factors were extracted that could be interpreted as follows：“philosophy/management policy,” “management approach,” “workplace ambiance,” “evaluation of the organization,” and “self-evaluation of the employee's own job.”

　Examination of a hypothetical model where “philosophy/management policy,” “management approach,” and “workplace ambiance” affected “evaluation of the organization” and “self-evaluation of the employee's own job” revealed that, for pharmacists, it was “philosophy/management policy” that had more influence on, and correlation with other factors, while it was “workplace ambiance” for administrative staff members.

　These results indicate that correlations of factors differ depending on the job；to improve the evaluation of the organization and of the employee's own job, empathy and permeation of the pharmacy organization's philosophy and management policy are important for pharmacists, while workplace ambiance is important for administrative staff members. This provided useful suggestions for human resource management in community pharmacies.

To create meaningful cost reports, a better definition of cost and range of costs is needed in order to reduce current uncertainties that still occur in conferences and papers regarding hospital cost accounting.Hospital Cost Accounting Committee (HCAC) of Japan Society for Health Care Management (JSHCM) has continued to discuss this critical issue in hospital cost accounting systems in order to better facilitate communication between stakeholders.

The society recognizes that meaningless cost report, unclear definitions of cost, and lack of range of costs caused confusions and misunderstandings.

Therefore, the committee sought to clarify these issues. In order to make meaningful and useful cost reports, members of HCAC suggest that a committee be formed to expressly define the object of cost and range of costs based on currently available Hospital Financial Reporting Standards. This initiative will help to ameliorate current problem in reporting. After instituting and sharing this basic information among stakeholders, cost reporters will be able to better analyze data. As an example, with a common definition of total cost, a medical cost and administrative cost will become more clearly defined and, thus, give more details of hospital condition from a cost accounting perspective.

The EkisaiNet medical information sharing system has been running since 2002. It is our hope that the use of this system will be expanded and will contribute to improve patient care through better sharing of medical information in the Nagoya area. EkisaiNet provides access to personal data, medical treatment orders, and diagnostic examination results. Security of data and system availability are critical issues in the health care field, and after trying several alternatives, the system uses PKI-USB+SSL-VPN, which provide satisfactory security with acceptable cost and reliability. However, other impediments still remain to the seamless coordination of regional alliances, and EkisaiNet is expected to play a role in solving these problems. In this report we propose using EkisaiNet to coordinate regional alliances in the adoption of a “critical path”.

Agreement on migration of nurses and caregivers is a component of the Economic Partnership Agreements (EPA), which is an international trade agreement aiming at reducing tariffs. Current Japanese acceptance scale of nurses and caregivers is so small, comparing other countries' situation, that it would hardly have any impact on Japanese domestic labor market. The source countries could learn nursing care techniques through EPA program for coming aged society. Japan is requested to consider the acceptance of foreign nurses and caregivers because of severe shortage in near future. It needs to start national debate on this issue paying special attention to mutual merits for both host countries and source countries.