The Journal of Japan Society for Health Care Management
Online ISSN : 1884-6807
Print ISSN : 1881-2503
ISSN-L : 1881-2503
Current issue
Displaying 1-8 of 8 articles from this issue
Original Articles
  • comparison between academic medical centers and the other acute care hospitals
    Ryo Onishi, Kunichika Matsumoto, Yosuke Hatakeyama, Kanako Seto, Shige ...
    Article type: Original Articles
    2020 Volume 21 Issue 1 Pages 2-6
    Published: July 01, 2020
    Released on J-STAGE: January 17, 2025
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    The regional medical plan sets the maximum number of hospital bed, and the uniform calculation formula is used nationwide for each secondary medical area reflecting the gender and age group population, the bed utilization rate, etc. It does not consider the difference in function of hospitals. In addition, when inpatients come from outside the prefecture, the number of maximum beds may become lower than the actual required number of beds. The purpose of this study is to clarify that there is a difference in the inflow rate of inpatients from outside the secondary medical area depending on the type of hospitals.
    Using the “Patient Survey” in 2017 and the “Medical Facility Survey” in 2017, the inflow rate of hospitalized patients from outside the secondary medical area was compared between the academic medical centers (specially designed hospitals and university teaching hospitals) and the other acute care hospitals. Kruskal-Wallis test was used for significant difference at a significant level of 5%, and multiple comparisons were performed using the Dunn test. Based on an analysis of 3,551 acute care hospitals, the proportion of inpatients from outside the secondary medical area in the academic medical centers was 47.5%, which was significantly higher than the other acute care hospitals. In academic medical centers with highly specialized medical functions, many patients are hospitalized from outside the secondary medical area, and significant part of the beds is used for patients who are not inhabitants of that secondary medical area. Therefore, in secondary medical areas with academic medical centers, there is a possibility that access to inpatient care for local residents may be hindered, and the way to handle the academic medical center should be considered in calculating the maximum number of beds.

  • Miyuki Ueno, Kazuko Yamada, Ikuharu Morioka
    Article type: Original Articles
    2020 Volume 21 Issue 1 Pages 7-13
    Published: July 01, 2020
    Released on J-STAGE: January 17, 2025
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    This study aimed to clarify factors related to hesitancy and reluctancy to point out errors in nurses with clinical experience of 3 years and more and to obtain suggestions for medical safety measures in hospitals.
    Participants were 1,266 nurses (effective response rate 61.3%) with clinical experience of 3 years and more who worked in hospitals with 200 beds or more in A Prefecture, Japan. An anonymous self-administered questionnaire survey was carried out on attributes, work conditions, failure trends, experiences of errors, stress reactions, safety climate of medical institutions, and hesitance/reluctance to point out errors. A scene was set where pointing out errors would make one feel offended as the communication scene. Using the scores of hesitance/reluctance to point out errors in this scene as a dependent variable, the multiple linear regression analysis (stepwise method) was performed.
    As the results, three factors, “narrowing of cognition,” “forgetting /neglecting to use the bed stoppers,” and “an atmosphere that an error is permitted unless it is known to others” were positively related to the scores of hesitance/reluctance to point out errors. Three factors, “an atmosphere that a difficult and complex argument about medical safety is discussed thoroughly,” “Higher-level position”, “Fun to talk with people” were negatively associated with the scores.
    These results suggest that in order to reduce the hesitancy/reluctancy for pointing out errors in nurses, assistances would be necessary to foster a climate that actively tackles accident prevention and to make use of error experiences and to enhance positive reaction.

  • Mirei Onitsuka, Chiyoko Inomata
    Article type: Original Articles
    2020 Volume 21 Issue 1 Pages 14-19
    Published: July 01, 2020
    Released on J-STAGE: January 17, 2025
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    The purpose of the study was to clarify nursing practice environment as professional in nurses with a maternal role, and to identify the related factors. A questionnaire survey was conducted on 368 nurses with a maternal role while they were employed at 18 hospitals in A prefecture. The survey items investigated the capacity of the nursing practice environment as professional, as well as the related factors, including age, the age of their youngest child, and working conditions. The capacity of the respondent nursing practice environment as professional was evaluated using 21-items from subscales of the Japanese version of the Nursing Work Index-Revised (NWI-R). Data were analyzed by comparing descriptive statistics and NWI-R scores by age, the age of their youngest child, and work environment between groups.
    Analysis of the 253 valid responses collected revealed that the NWI-R scores were lowest for the subscale “support from head nurses”, followed by “nursing care quality assurance” and “working conditions.” This result suggested the need for improvement regarding “support from head nurse." There were no significant differences in the NWI-R scores of groups with reference to age, the age of their youngest child, and work environment.

  • Kouhei Yasuda, Masaaki Matoba, Yumi Kamijo
    Article type: Original Articles
    2020 Volume 21 Issue 1 Pages 20-24
    Published: July 01, 2020
    Released on J-STAGE: January 17, 2025
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    The additional medical coverage to maintain or improve activities of daily living started in 2014. This coverage is paid for physical therapist working full time in ward. The acute phase hospital introducing this coverage was as low as 4.9%, and in many hospitals, decline in revenue is stated as a reason not to introduce it. Little has been reported evaluating this coverage from an economic point of view. The purpose of this study is to examine the impact of this coverage on hospital management. This is a retrospective study at Showa general hospital. Study subjects were patients who stayed between December 2015 and November 2016 in the ward in which a physical therapist worked full time, and patients who stayed in the ward evaluating the need for placement of a physical therapist. The collected record contains number of days stayed. The number of patients in the ward where physical therapist worked full time was 1,558, while simulation group had 1,140. The total score of the additional coverage and fee-for-service rehabilitation was 147,900 higher for dedicated group than for simulation group. The implementation of additional medical coverage to maintain or improve activities of daily living leads to early initiation of rehabilitation, and it is expected to be effective for improving medical quality and contributing to hospital management.

Case Reports
  • Noriko Miki, Hidenobu Ochiai, Taro Asahara, Yoshio Onishi
    Article type: Case Reports
    2020 Volume 21 Issue 1 Pages 25-29
    Published: July 01, 2020
    Released on J-STAGE: January 17, 2025
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    Physicians' overtime hours are a major issue especially in acute care hospitals.
    Since fiscal year 2008, our hospital introduced medical assistants (MA) from the former East-West citizen's hospital and has been mainly focusing on outpatient clinical assistance work. We have strengthened the organization management system of MA and introduced the SMA (Special Medical Assistant) system as advanced level MA, and we have reduced the burden on physicians (69 physicians as of October 2018).
    In our hospital, we have reviewed and reorganized our organizational structure of MA, staff training method, introduction of team system and ability evaluation method and have been putting it into practice. In addition, overtime hours of physicians before and after introduction of SMA tended to decrease. From now on, it is necessary to practice various efforts for motivation improvement of MA.

  • Improvement of work efficiency by introducing medical assistants
    Akihito Moriki
    Article type: Case Reports
    2020 Volume 21 Issue 1 Pages 30-33
    Published: July 01, 2020
    Released on J-STAGE: January 17, 2025
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    At Mominoki hospital, we increased the number of medical assistants (MAs) along with the introduction of the electronic medical record on 20th June 2016. Currently seven MAs are doing outpatient and ward work of neurosurgery and ophthalmology. The MA's work in our hospital mainly consists of providing clinical information documents, hospitalization certificate, documentation support work such as doctor's opinion in nursing care insurance, discharging summary and examination, prescription, next visit reservation etc. They also substitute ordering system inputs, outpatient consultation assistance, registration and aggregation work of clinical data (JND registration), and some other related jobs. As an objective evaluation this time, we surveyed and examined five items;outpatient waiting time survey, discharge completion summary rate, period of preparation of doctor's advice in hospitalization certificate and long-term care insurance, satisfaction survey on doctors, and doctors' overtime hours. As a result, the average time from the reservation time of the reserved patient for neurosurgical outpatient to the start of examination was 10.9 minutes, and it was shortened to less than half the time before introduction. For the hospitalization certificate and the written opinion of the doctor in nursing care insurance, the average preparation period was 6.3 days, 8.1 days respectively, and the achievement rate within the target 2 weeks was 97.4% and 95.2%. The rate of completion within 2 weeks of the discharge summary improved, and the results of the satisfaction survey confirmed that the burden on the doctor was reduced. Introduction of MAs leads to work efficiency improvement, which appears to reduce the burden on doctors.

  • Kaori Honda
    Article type: Case Reports
    2020 Volume 21 Issue 1 Pages 34-37
    Published: July 01, 2020
    Released on J-STAGE: January 17, 2025
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    Despite the rapidly aging Japanese society, opportunities available for experts from different fields to discuss evidence-based practices and a treatment strategy for each case regarding treatment options and end-of-life care for the elderly are still limited in our hospital. In this context, the author organized an interprofessional death conference among care providers involved in a case which the author proposed. Since such conference may be useful to suggest universal implementation of interprofessional collaboration on treatment options and end-of-life care for the elderly in the future, its benefits are reported in this study. A handout with description of purpose, agenda, and discussion points of the conference, as well as hard copy of medical articles relevant to geriatric care in Japan and overseas had been distributed beforehand among care providers which complied of five occupations involved in this particular case, were then asked to check these materials before attending the conference. After the conference, a survey using self-description questionnaire was carried out to evaluate the learning effect of the conference. From results of the questionnaire, it was shown that all the participants were at least aware of importance of interprofessional collaboration on determining the treatment policy of geriatric care, and that each of the individual participants gained insights and possibilities regarding future practices in geriatric care. Providing opportunities of collaboration across different fields will potentially contribute to improve ethical sensitivity among medical practitioners and quality of professional practices in individual fields engaging in care for the elderly.

  • Yoshifumi Niinuma, Yoshiaki Narita
    Article type: Case Reports
    2020 Volume 21 Issue 1 Pages 38-43
    Published: July 01, 2020
    Released on J-STAGE: January 17, 2025
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    From 2014, DPC hospitals are recommended to prioritize generic medicines as part of their functional performance review, and our hospital is actively working towards this goal. Our pharmacy team discusses to evaluate original and generic medicines and determines which medicines will be stocked and included in the hospital formulary.
    We evaluated original and generic medicines which were due to be switched during the period of April 2014 to September 2017. A total of 77 different medicines (95 different dosages in total) were included and a scored evaluation was calculated for each.
    The mean results of each major category are as follows (listed as original medicine/generic medicine respectively):Supply system 7.8/5.9 (p<0.01), Documentation 2.7/2.3 (p<0.01), Information provision 5.5/4.9 (p<0.01), Pharmacokinetic data 4.7/2.6 (p<0.01), Risk management 5.2/7.8 (p<0.01), Quality 4.1/3.9, Overall score 29.9/27.3 (p<0.01).
    Generic medicines had equivalent quality scores, but original medicines scored higher in the supply system, documentation and information provision categories. Therefore, when switching to generics it is crucial to provide adequate information to hospital staff and to ensure a steady supply of the drug. Then, we evaluated the names, appearance of these generic medicines including whether they were easy to discriminate from other medicines. Our tabulated risk score showed that generics performed better than original medicines. We were also able to show a reduction in overall cost by switching to generics, and we would like to continue to evaluate for safely providing generics to our patients.

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