The purpose of this study is to reveal facilitating and obstructing factors of implementing hospital cost accounting system. A literature review was conducted under the framework of previous studies on managerial accounting.

According to the review, the need of human resources is mentioned in terms of “personal attributes”. Calculation accuracy associated with the purpose of cost accounting is also emphasized related to “system design”. The result also shows that impotance of internal communication has been repeatedly mentioned for “implementation process”. In addition, attention to cost objectives and improvement process are regarded as “achievements of cost accounting” whereas financial performance is not commonly mentioned.

This study analyzed the social cost of the Dementia (ICD-10：F01,F03,G30) in Japan from the published data. We estimated it using the Cost of illness method (COI method). The total cost increased 1.78 times in 10 years from ¥1.20 trillion in 2002 to ¥2.13 trillion in 2011. When we calculated the contribution of each cost of the overall increase, it consisted of 12.5% in Medical cost, 5.8% in Morbidity cost, 6.7% in Mortality cost, and 75.1% in Care service cost (43.9% in Home care cost, and 19.0% in Community-based care cost,12.2% in Facility care cost). It was difficult to attribute all to the aging population, but it could be understood partly because of social-well recognition as well as early diagnosis of dementia with advances in medical technology. Currently, “Deinstitutionalization” is being carried out in Japanese medical policy. The relative percentage of the cost of out-of-hospital and out-of-facilities (Out-patient expenses, Community service cost, and Home service cost) had risen from 20.1% in 2002 to 43.5% in 2011. In particular, the Care service cost had 76.7% of the total social cost and accounted for 75.1 % of the total increase. How to manage the high contribution of Care service cost in the super-aged Japanese society is an important issue to be considered.

We examined the effect of home visiting and day rehabilitation facility service on primary caregivers from the perspective of health-related quality of life (QOL) to investigate the nature of rehabilitation at home services.

Rehabilitation was divided into home visit, day rehabilitation facility service, and combined rehabilitation. After ascertaining the characteristics of changes in SF-36 score from the start of rehabilitation to 6 months after starting rehabilitation, multiple comparisons were conducted to investigate the difference in scores among the three groups.

As a result, while primary caregivers maintained their “mental health (MH)” irrespective of the type of rehabilitation they used, their “physical functioning (PH)” did not improve, which suggested a possible link with exacerbated caregiving burden. Furthermore, day rehabilitation service is characterized by the time away from caregiving for the caregiver, which may contribute to improvement in “physical pain.” Items that were improved in the day rehabilitation service and combined rehabilitation groups were “overall sense of health (GH),” “social functioning (SF),” and “role functioning (RE),” indicating that the use of day rehabilitation service played an important role in the mental health of primary caregivers. A comparison of scores among the three groups revealed significant improvement in the combined rehabilitation group. Simultaneously providing home visit and day rehabilitation service to primary caregivers who feel “exhaustion and a lack of energy” and are “unable to ensure time for work or normal activities” is much more likely to have an effect.

Providing home visiting and day rehabilitation facility service is useful for improving the health-related QOL of the primary caregivers. It is thus important to provide rehabilitation by taking advantage of the characteristics of improvement resulting from the type of rehabilitation. Further, a multilateral rehabilitation system is anticipated following the improvement observed from combining the types of rehabilitation.

In order to increase medical staff self-awareness regarding medical errors at the individual level, the staff in our hospital was required to review their previously conceived beliefs concerning five key areas of patient safety；“everyone can make mistakes”, “medical staff's viewpoint”, “individual responsibility”, “medical safety”, and “the more reports of medical errors, the better”. Newly emphasized notions are as follows：“everyone can prevent mistakes”, “patients' viewpoint”, “hospital responsibility”, “patient safety”, and “the less reports of medical errors, the better”.

In addition to the change of ideas as mentioned above, the campaign of “Prevention of Administrative Errors” was launched in April, 2012.

After the campaign, the average number of administrative errors fell from 11.8 cases a month to 6.9 cases, an overall 41.5 % reduction. Errors committed between the prescription of medicine and hand-over of these to nurses decreased by 64.2 %. However, the percentage of errors in the process of nurses' preparation and delivery of medicine to patients increased by 14.0 %.

This campaign based on changing some beliefs had a positive effect, but further improvement is needed to satisfy patients' expectation.

Moreover, in order to assure a quality of patient safety, a combination of both strong leadership from the hospital's administration and cooperation from the medical staff is required. There is also the need to further improve the quality of education of medical students regarding patient safety.

It is imperative for acute care hospitals to establish a treatment system to promote early recovery of inpatients and their adaptation to everyday life after hospital discharge. In this study, we focused on the nursing services that were necessary for perioperative patients and categorized the services into those which had already been moved to the outpatient department from the hospital ward and those which seemed appropriate to be moved to the outpatient department from the standpoint of a ward nurse who admits patients.

Anonymous questionnaire survey was conducted on nursing managers in the perioperative wards of 274 institutions in the South Kanto area. It found that confirmation of and guidance for hospital admission and preoperative preparation were considered as appropriate to be conducted at the outpatient department and some of them had already been shifted to the outpatient department. On the other hand, 2 items in the confirmation of patient's basic background, 7 items in the explanation of and guidance on the day of surgery and the postoperative recovery period, and 10 items in the confirmation of and guidance for the life after admission were found to account for less than half even after the services shifted to the outpatient department and those considered as appropriate to be conducted at the outpatient department were combined. It can be said that it is necessary to clarify the issues facing patients in the perioperative period and to create a system for the outpatient department, the hospital ward, and the home care assistance department to work collaboratively so that patients themselves can take proactive steps and adapt to the changes of the postoperative life.

To promote team medicine, staff and nursing assistants have been increased to over 80 people in hospital A. There are some educational problems among the increased staff due to the difference in educational background and that they do not have knowledge and skill about medical care and nursing. Therefore, nursing administrator needed to clarify knowledge and technological need for nursing assistants so that the nursing staff and nursing assistants can cooperate to provide safe and quality service. A new procedural manual was developed for nurses that focused on deepening the understanding of work contents and roles of nursing assistant, and appropriate duties request and transfer of work. And for nursing assistants, one that focused on their role and to execute service under appropriate processes. We studied reports from a 3-month period under this new manual to clarify the future problems related to the delegation of work. The results are as follows：1. In the categories of living environment and medical examination and treatment, “They have been put into effect” is 80.6%, 79.9%. Of these, “They can do by their selves.” is 96.2%, 94.1%, “They adhere to procedure” is 81.0%, 85.8%. 2. In the category of daily life, “They have been put into effect” is 46.4%, and “They adhere to procedure” is 67.7%, it was low. 3. The reason that the work is not conducted, “They are not instructed to” is 42.3%. Our next step is to provide instructions in job items that are not given any at present, to actively delegate work to the nurses, and to further promote the new manual.

This paper proposes the relational database based on the system method, and attempts to clarify past and present problems in utilizing receipt claim data.

Health insurance claim is now submitted online using an electronic medical receipt data. The online medical receipt data structure is difficult to be used secondarily, but they store important data of the patient same as “DPC data” and “Electronic medical record data”.

In this case report, application efficiency was improved by relational database, and the secondary use of medical receipt data was possible including searches and analyses.