The purpose of this study is to identify the difference of patient safety management system and the activities between acute care and long term care hospitals relating to the experience of serious adverse events, and to investigate effective support plans.

In September 2011, a questionnaire regarding the experience of serious adverse events, patient safety management system and activities was delivered to 3,890 hospitals by mail. Response rate was 32.4%. The experience of serious adverse events was related to bed size, assignment of a safety manager and use of root cause analysis (RCA) in acute care hospitals, and to use of RCA or SHELL in long term care hospitals. In acute care and long term care hospitals with the experience of serious adverse events, the assignment of a safety manager was not related to any patient safety activities. In hospitals without the experience of serious adverse events, the assignment of a safety manager was related to “use of RCA”, “manual or casebook based on reported cases”, “assignment of a person in charge of patient safety education” (in acute care hospitals only) and “patient safety education programs” (in long term care hospitals only). The assignment of a safety manager may contribute to establish patient safety management system in hospitals without the experience of serious adverse events. Among the respondents, 26.3% of acute care hospitals and 67.6% of long term care hospitals did not have the experience of serious adverse events and did not have a safety manager. The support plans to assign a patient safety manager or to activate the patient safety activities should be considered as policy challenges and research tasks with high priority.

The implementation of DPC/PDPS (Diagnosis Procedure Combination/Per-Diem Payment System) requires the learning of new work competencies for hospital clerks as well as developmental support for these competencies. However, hospital workers' training is often modelled on training programs designed for companies, without sufficient validation of their propriety and effectiveness for medical professionals.

This study compares career anchors-the most appropriate work styles for a person-of university hospital clerks and company employees as well as considers the propriety of corporate career development support policies for university hospital clerks. The study examines the relationship between career anchors and career development support policies appropriate for the attributes of university hospital clerks and then derives policies conducive to career development.

To test our hypotheses for the two objectives, we conducted a visit survey using an anonymous questionnaire targeting both university hospital clerks and company employees. Valid responses were received from 106 individuals. Then, data from the survey were examined to validate the hypotheses and further analysis was performed.

The results demonstrate that in the career anchor category, the percentage of technical/functional competence and lifestyle in both university hospital clerks and company employees is high, with no significant difference. Therefore, we conclude that it is appropriate to apply company policies to university hospital clerks. In addition, we identify a trend of prioritizing work-life balance and simultaneously improving workplace professionalism, which suggests that the assessment, career paths, career consultation, as well as dual-track human resource systems are all effective policies.

Although pharmacists participate in vancomycin (VCM) administration planning in hospital-acquired methicillin-resistant Staphylococcus aureus (HA-MRSA) pneumonia, their contribution has not been assessed in terms of health economics. Here we report comparative cost-effectiveness study on VCM administration planning in HA-MRSA pneumonia based on medical records. We separated the patients into two groups；pharmacist participation group (15 patients) and control group (15 patients). In the pharmacist participation group, incidences of nephrotoxicity and expected cost were 0% and 419,088.0 yen, respectively, while in the control group, the results were 13.3% and 485,610.5 yen, respectively. Thus, we demonstrate that the pharmacist participation group is a more beneficial strategy, as it is safer and has lower cost compared to the control group. Hence, VCM administration planning by pharmacist in HA-MRSA pneumonia is recommended in terms of medical economics, for its better safety and shorter treatment duration.

Since the 3rd revision of Medical Service Law in 1997 in Japan, informed-consent has been clarified as a legal duty at each medical setting. However, although the legal meaning of the “setsumei (inform)” was shown in the judicial precedent, the legal meaning of the “doui (consent)” has not been clarified. Then, we investigated on what is “doui ” in the judicial precedent on the analysis of judicial precedents related with the medical issue case. The “TKC low library” (LEX/DB) of the judicial precedent database was used, and retrieval by keyword was conducted. The keywords were “informed-consent”, and its Japanese translation “setsumei to doui (explanation and consent)”, and also “doui ” and its Japanese synonym, “goui (agreement)”, and “shoudaku (consent)” were selected. The number of judicial precedents extracted as a result of search was 128. All were scrutinized, and 20 cases which showed about the “doui ” were listed on the table. The total number of the judicial precedent on the (LEX/DB) database was 243,324, and the number of stored magazines was 127 (as of March 23, 2013). The number of the cases related with the keyword “informed-consent” was 125, and that of the case with “setsumei to doui ” was 32. Moreover, as for other key words “doui ” was 22,024, “goui ” was 31,918 and “shoudaku ” was 33,880. Among the Supreme Court judicial precedents, what is the “doui ” has not been clarified；however, there were some lower court cases which described the “doui ” of its judicial meanings and aspects. Some suggested the relationship between the “consent” and the consent form, which was widely used at each medical setting at this moment. On the other hand, there was another opinion that the strict tight-laced informed-consent might have given some impulse to the increasing recent tendency of a doctor's labor.

In case of serious adverse event, in-hospital patient safety committee is expected to play a principle role in investigating the cause of the event and in developing preventive methods. No standard method as to the analysis or the contents of the report has been established, and it is difficult for other hospitals to utilize the results of the investigation in preventing similar events. The aim of this study is to reveal the present situation of recorded items in the report, and the means to make the reports available to other hospitals.

All member hospitals of the All Japan Hospital Association and stratified samples of non-member hospitals were requested to answer the questionnaire in September, 2011. The questionnaire included questions about the experience of serious adverse events and recorded items in the reports. By using cluster analysis, the reports were classified based on the recorded items.

The response rate was 32.4% (1,261/3,890). Among them, 34.9% experienced adverse events during past 3 years. The reports were classified by its' characteristics of description items into 2 types；cluster A (n=177) and cluster B (n=100). In comparison with cluster B, cluster A had a tendency to keep parties' anonymity, to receive support from external experts for the investigation and to record important items, which would affect the quality of the report, such as the cause of accident and preventive methods. In addition, 58.2% of hospitals answered that the item of “an evaluation method regarding the state of implementation and the effectiveness of preventive method” was not needed in the report.

To encourage “the reports intended to publicize” with “an evaluation method regarding the state of implementation and the effectiveness of preventive method” might be effective for other hospitals to utilize the results of in-hospital investigation.

Due to the medical procedure for terminal patients who were suffering from chronic heart failure which commonly include administration of diuretics and cardiac stimulants via continuous intravenous injection such as catecholamine, the patients are often forced to extend their stay in hospital, resulting in low quality of life (QOL). However, if the circulatory system was maintained stable with appropriate drug administration, it is certain that some percentage of patients were able to stay in their self-reliant recuperation environment. Thus, the possibility of realization of medical management for home care patients by respecting their own intentions cannot be denied. In such a patient group who prefers to receive at-home care treatment with an appropriate recuperation environment, support from their family and a close coordination among homecare facilities, physicians, as well as logistic medical service must be required. We have constructed and utilized such network-system called “Ohisama-Network”, consisting of both specialized medical personnel for home care and staff with no specialized qualifications, to practice a smooth cooperation across professions around our clinics to support patients. We report a significant case study how Ohisama-Network contributed to improve QOL of home care patients with a terminal state of chronic heart failure, who were unable to disengage from catecholamine. Furthermore, we report some practical approaches of home healthcare via Ohisama-Network. In order to introduce patients with serious conditions into home care and improve their QOL, unconventional framework and substantial cooperative relations across professions must be urgently developed.

In 2009, the Health Networking Center of K University Hospital launched a plan for the development of discharge planning nurses in hospital wards. In 2010, 26 nurses selected from all wards were given a training program and in 2011, a discharge planning body was organized around this group of participating nurses, Now this body of nurse group coordinates discharge planning operations in all wards with the program-graduated nurses at each station.

Three self-administered questionnaires were conducted；before and after the training program and one year later, to ask the participants for the evaluation scales of the discharge planning and the changes of their awareness, action and nursing activities regarding the hospital discharge coordination. The results of 19 nurse respondents show a dramatic enhancement of their consciousness within one year after the training program and the significant increase in the number of nurses tries to obtain the information of societal resources and to transcend their specialties of the discharge planning. Also, the number of nurses taking real action of the discharge coordination in the hospital increased. Those nurses indicate the alteration in their nursing behavior toward hospitalized patients like collecting the information and implementing an intervention considering patients' lives after discharge from the very beginning.

Thus, it can be concluded that the training program has a beneficial influence on nurses' awareness and actions regarding the discharge planning and is quite useful as a multiple learning style. However, it does not mean that all process has been practiced completely. We need to utilize grand round and regular meetings for the discharge planning actively and to continue the promotion of education. Through the training program, the discharge planning should be addressed not only among discharge planning nurses but also in an entire hospital with positively enlisting cooperation from doctors and ward staff members.

Although hospitals were concentrated in the neighborhood of Fukui-ken Saiseikai Hospital (hereinafter referred to as this “Hospital”), a division of labor according to functions and areas of specialization in medicine were not well established among them. Consequently, a strategy was required to become the “hospital chosen by local communities.” In order to achieve such a strategic target, we created and analyzed a map of inpatient distribution by region using DPC data and a geographic information system. First, inpatients and referred inpatients were extracted by disease group in accordance with the Major Diagnostic Category, and a map of their distribution was created using mesh data or data by district. In addition, as a means of revealing distribution in surrounding areas, the locations of collaborative physicians were plotted into the mesh data that contained only the data of inpatients at the Neuroscience Center. Furthermore, a distribution map of patient concentration was created based on the mesh data to analyze how it differed from the distribution map of the number of patients. Geographic visualization by way of distribution maps enabled us to have a detailed grasp of the areas in which this Hospital had been able to provide medical services up to the present and the areas in which it can offer those services in the future. This analysis enabled us to understand the “strengths and weaknesses” of this Hospital in the regional medical collaboration, which was useful for this Hospital in setting the target for its regional medical strategy for the future.

The subject of the investigation was Public Hospital “A”(with approximately 300 beds) from April, 2010, until February, 2011. Data was collected and analyzed concerning how the hospital management indicator affects the determination of patient condition severity and nursing requirements. It became clear that as the number of patients with high severity and high nursing requirements increased, the number of operations performed also increased. And it became evident that as the number of patients with high severity and high nursing requirements increased, so did the number of patients being discharged. In order to keep the nursing requirements per patient condition severity constant and to appropriately claim medical treatment fees, it will be necessary to improve the referral system.

The purpose of this study was to indentify contributing factors in job satisfaction and human relationship in office workers in the hospital. A questionnaire survey was conducted on all 3,865 employees with exception of doctors at the S University facilities (8 hospitals and 1 clinic). This study focused on 255 office workers who responded to this questionnaire. The 26 questions was classified by applying methods by Stamp et al into 6 categories；“Administration”, “Task requirement”, “Pay”, “Autonomy”, “Human relationship”, and “Professional Status.” Furthermore, “Human relationship” was classified into 3 components；relationship with supervisor, with coworker and with other section personnel. Contributing factors to job satisfaction were clarified using multiple regression analysis. “Human relationship” was most influential on job satisfaction for office workers, more than “Pay”. Among category of “Human relationship”, strongest relationship was found with supervisor, and secondly with other section personnel and lastly with coworker. The results of this study suggested that human relationship, especially with supervisor than with coworker, is important to improve job satisfaction.

Fukuyama Medical Center introduced doctor assistant (DA) staffs in July 2010, and tried to expand their activities with the close cooperation of nurses. Improvement in clerical work was evaluated by comparing before and after the introduction of DA staffs in the division of orthopedic surgery. Before DA staff introduction, the rate of discharge summary report and postscripts to previous hospitals were 20 % and 60 %, respectively, and both of which were increased to 100% after DA staff introduction. Moreover, all the various medical certificates were completed within 2 weeks. In consequence, doctor's clerical work time showed mean reduction of 2.5 hours/day per surgeon, resulting in increase of orthopedic operation cases. All surgeons and nurses in the orthopedic division highly evaluate the performance of DA staff. In conclusion, the introduction of DA staff not only reduced the workload on doctors but also enabled smooth progression of the flow of surgical treatments from admission to discharge.

Physical Therapist Presentation (PTP), since opening of hospital in 2006, is the opportunity of expressing themes selected by physical therapists. Physical therapists as participants of PTP gradually increased with repetition. Review reading was adopted since the year of 2012 and forty-nine presentations among seventy-four registered presentations were accepted in this year (66.2% of adoption rate). We held 64 PTPs including 290 themes in these seven years.

This report suggested the importance of management for physical therapists of creating and supporting active participation toward learning in organizational group. In addition, transformation of individual knowledge of “who knows what” to the collective knowledge of “we know what” would lead management in organization more efficient.