New Challenge For Patient Safety Patient Safety in JapanMy C.V. Graduation: Poor post-graduation...
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The Seventh Annual Quality Colloquium New Challenge New Challenge For For Patient Safety Patient Safety in Japan in Japan Toshihiko Hasegawa Toshihiko Hasegawa , , MD.,MPH.,PhD MD.,MPH.,PhD Nippon Medical School Nippon Medical School August 21, 2008 Cambridge, MA
Transcript of New Challenge For Patient Safety Patient Safety in JapanMy C.V. Graduation: Poor post-graduation...
The Seventh Annual Quality Colloquium
New ChallengeNew ChallengeFor For Patient SafetyPatient Safety in Japanin Japan
Toshihiko HasegawaToshihiko Hasegawa, , MD.,MPH.,PhDMD.,MPH.,PhDNippon Medical SchoolNippon Medical School
August 21, 2008Cambridge, MA
My C.V.Graduation: Poor post-graduation education in JapanResident: Generaｌ Surgery, St. Joseph Hospital (Milwaukee, US)
Student：
M.P.H Harvard School of Public Health (US)
Educator： Assistant Professor of Gastrointestinal Surgery:Shiga Univ. of Medical Science
National Cancer Center: Director o Planning OfficeDeputy director of the Elderly Care Div, MHLWDirector of Health ODA, JICA Vice President, Kyushu Region National Hospitals
Bureaucrat
1975
1980
1985
1990
1995
Researcher：1995
2000 Director of Health PolicyNational Institute of Health Services Management
National Institute of Public Health2005
Researcher & EducatorNippon Medical School
DeathＣTHasegawaNMS, Japan
from Bureaucrat to Researcher
Japanese bibJapanese bibfor the for the
Patient SafetPatient SafetInitiativesInitiatives
Did Research on Did Research on Patient SafetyPatient Safety
Advised Advised Government for Government for PolicyPolicy
DevelopedDevelopedTeaching ProgramTeaching Program
PARTPART 11
For Your SurpriseFor Your Surprise
Can You Learn from Japanese Experience?
Yes a lotIn the case of other industries!
Not yetIn the case of health industries!
ＣTHasegawaNMS, Japan
Why Japan is Champion in Quality ?
Not because factories are excellent
But because Japanese customer is very demanding
Yes in the case of other industries
Why not in the case of health industriesBecause Japanese patient was not very demanding
So hospitals did not need to prepareFinery Changing
ＣTHasegawaNMS, Japan
Why Changing?Trigger
Medical Accident-Yokohama Medical School Wrong Patient Surgery !
Background
International influence :Pizza Syndrome
Consumerism-Baby Boomer Becoming PatientCost Drive-Rapid AgeingStanderdization-Outcome Orientation
PolicyFunctional Differentiation-Length of Stay Shortening
ＣTHasegawaNMS, Japan
Pizza Syndrome
Invite Me Again in 10 years!
Or Like a Dr Deming CaseWe will learn from you & make it better
Foreign reputation defines domestic valueItalians did not know pizza is gooduntil Americans told them so
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PARTPART 22
TriggerTrigger
Historical Trend of Number of Accredited Hospitalｓ
by JCQHC
0
500
1000
1500
2000
2500
3000
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Yokohama Accident
Additional Payment
Very Slow！
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Medical Lawsuits FiledMedical Lawsuits Filed
200
300
400
500
600
700
800
900
1000
1100
19921993199419951996199719981999200020012002 2003
44 56 103
142 14
513
710
8235 266 221
796
1,606
1,457
1,557
1,593
0
200
400
600
800
1000
1200
1400
1600
1800
1989 90 91 92 93 94 95 96 97 98 992000 01 02 03Year
Yokohama Accident
Yokohama Accident
Articles on Medical Errors Articles on Medical Errors
In 5 Major Newspapers In 5 Major Newspapers Counted by the Supreme CourtＣTHasegawaNMS, Japan
US UK Australia Japan 1995 Dana Faber Accident Accident
Epidemiological Report
1996 President Council for Quality of Care
Quality Task Force Report
1997 Bristol Royal Infirmary Accident
1998 A First Class Service 1999 IQM Report Yokohama City
University Accident 2000 QuIC Report An Organization with
Memory Safety First
2001 Building a Safer NHS for Patient
National Action Plan 2001
Patient Safety Action (PSA)
2002 National Strategic Plan
International Consequence
for Patient Safety and Quality Improvement
ＣTHasegawaNMS, Japan
History of Patient Safety Activity in JapanHistory of Patient Safety Activity in Japan19991999 Accident at One Reputable Teaching Hospital
20002000 Teaching Hospital Patient Safety System
20012001Division of Patient Safety at Ministry of Health, Labor & WelfareNational Council for Medical SafetyResearch Funding
20022002 Comprehensive Strategy for Patient Safety
20032003National Complaint SystemEpidemiological Study on Medical Accident
20042004National Reporting SystemSystem for Analysis of Deaths Related to Medical Accident
People
Health Institution
LegalField
Ministry of Law
Ministry of Science & Education
Insurance Bureau
Pharmaceutical Bureau
Ministry of Economics &
Industry
InsurerMass Media Academic Provider
AssociationHealth
IndustryOther
Industry
Patient Law
Insurance
National Patient Safety System Development
StakeholderStakeholder
GovernmentGovernmentPolicy Bureau Health Ministry
ConsumerConsumer
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MHLW Council &Committee on Patient SafetyMHLW Council &Committee on Patient SafetyNational Council for Medical SafetyNational Council for Medical Safety
Formulation of mid & long term policy & emergency measuresEvaluation & advice on medical safety measures in Japan
Human Error Div. Safety of human/organizational
factorsExam of measures of securing
of mng’nt system
Pharmaceuticals & Medical Devices Div.
Exam of security mng’nt measures relevant to physical factors
Div. of Handling of Medical Accident Info
Exam of measures of handling of info on medical accident
Study Group on “Near Miss” CasesAnalysis of “Hiyari-hatto” cases
Exam of measures for improvement
Study Group on Range of Reporting Accidents
Exam of range of reporting medical accidents
Standard WGMark similarity WGInjection formal similarity WGTransfusion WGEye Drug WG
May 18, 2001 –
June 28, 2001 – April 25, 2003August 8, 2001 – June 10, 2003 July 29, 2002 – April 15, 2003
July 29 2003 -October 2001 – September 29, 2003ＣTHasegawaNMS, Japan
History of Institutionalization of In-hospital Patient Safety by MHLW
April 2000University Hospital
October 2002All hosp &
clinics with beds
April 2003UniversityHospital
Guidelines Guidelines →Goal
Committees Committees Managers/ administrative dept →Organization
Training Training →Awareness
Report Report →Knowledge
Patient counseling system
2004.10
National Accident Reporting
SystemＣTHasegawaNMS, Japan
History of Patient Safety Activity in JapanHistory of Patient Safety Activity in Japan19991999 Accident at One Reputable Teaching Hospital
20002000 Teaching Hospital Patient Safety System
20012001Division of Patient Safety at Ministry of Health, Labor & WelfareNational Council for Medical SafetyResearch Funding
20022002 Comprehensive Strategy for Patient Safety
20032003National Complaint SystemEpidemiological Study on Medical Accident
20042004National Reporting SystemSystem for Analysis of Deaths Related to Medical Accident
2005 2005 RevisionRevision of of Comprehensive Strategy for Patient Safety 2002Comprehensive Strategy for Patient Safety 2002
Hospital Ranking & Benchmarking
Accident Triggered the Interest in QualityＣTHasegawaNMS, Japan
3 Main Focus of New Strategy 20051 Quality & Safety1 Quality & Safety2 Preventive Measures based on Analysis 2 Preventive Measures based on Analysis
of Reported Casesof Reported Cases3 Patient Participation3 Patient Participation
1 Third Party Investigation of Fatal Cases 1 Third Party Investigation of Fatal Cases Related to Medical AccidentRelated to Medical Accident
2 2 NonfaultNonfault CompensationCompensation for Birth Injuryfor Birth Injury
Current 2 Hot Issue Discussed 2008
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Historical Consequences
Risk Management
Many Law suits
Good Tradition
Not Well Established
Emerging
Safety Management
Quality Management
Risk Management
Quality Management
US JapanＣTHasegawaNMS, Japan
PARTPART 33
BackgroundBackground
Average Length of Stay1960-2006
0
10
20
30
40
50
60
1960196519701975198019851990199520002005
Japan General AverageRed CrossPublic InsuranceCompanyPhysician OwnedUniversityAustraliaGermanyNetherlandsSwitzerlandUnited KingdomUnited States
OECD &OECD & Japanese Gov StatisticJapanese Gov Statistic
DaysMainly Nursing Home Physician Owned Hospital
convergence
Acute Care Hospital Mainly Public Hospital
OECD country
JAPAN by ownership
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diagnosisdiagnosis therapytherapy recoveryrecovery×
outpatient testing
hosp. labs, op. rms. outpatient
care
rehab. facilities, long-term care facilities, home
care, hotels
therapy therapy (contd.)(contd.)
Nur
sing
nee
dN
ursi
ng n
eed
various various teststests
intense intense treatmenttreatment
additional additional treatmenttreatment
recovery recovery towards selftowards self--
carecareA
B
C
Change in Expectation to Hospital
US
Europe
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20 years ago & now Shifted
Japan
US 4-5days
Percentage of the Elderly (over 65)
0
5
10
15
20
1960 1970 1980 1990 2000
AustraliaAustriaBelgiumCanadaCzech RepublicDenmarkFinlandFranceGermanyGreeceHungaryIcelandIrelandItalyJapanKoreaLuxembourg
％ Surpassing Germany and Italy in 2002 to top the world
Japan is now the frontrunner!!
OECD HEATH DATA ２０
０
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World Highest in 2004World Highest in 2004
USA
Population Estimation by age 1884-2150
0
2000
4000
6000
8000
10000
12000
14000
1880 1900 1920 1940 1960 1980 2000 2020 2040 2060 2080 2100
万PeakPeak
Toward Super Toward Super Aged SocietyAged Society
Total
Over 50Over 50 Over 60Over 60Over 65Over 65
Over 75Over 75Over Over 8855Over Over 9090
PresentPresent
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PARTPART 44
PastPast
By Dr MinamiBy Dr MinamiStructure of Edo SocietyStructure of Edo Society
Root of Japanese Modern Hospitals Root of Japanese Modern Hospitals Established in 1722Established in 1722
framing hospitals as a social systemKazuo Minami “Social Structure of Edo”, Hanawa Shobo.
Koishikawa Hospital
The Model of Akahige’s Hospital
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The Koishikawa Hospital and the Edo Era
020406080100120140
1600 1650 1700 1750 1800 1850 1900
Kyoho Reform
Kansei Reform
Tempo ReformRule of
Tanuma Okitsugu
Genroku Period
“Rule of Ogosho’s”
Rise and Establishment of the Edo Era Fall of the Edo Era
Edo Government
Kazuo Minami “Social Structure of Edo”, Hanawa Shobo.ＣTHasegawaNMS.Japan
No of Beds Public Hospital 1722
Bad Reputation
1820-30
Annual Treatment Outcomes at the Koishigawa HospitalKyoho Reform Kansei Reform Tempo Reform
Cure rate
Death rate
0
10
20
30
40
50
60
1700 1750 1800 1850 1900
Meiji Restoration％
Kazuo Minami “Social Structure of Edo”, Hanawa Shobo.ＣTHasegawaNMS.Japan
Hospital Mortality Study
140 years before Nightingale
Treatment Outcomes by Each Physicians % Cured 1832 & 1833
internal medicine residents surgery ophthalmology
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%小川太左衛門
峰岸昌菴
井上玄丹
小川謙次郎
高木済菴
井上三菴
鎌田庭雲
塙主齢
成田活元
西玄長
牧野升朔
馬場瑞伯
1831-1832
1832-1833
Kazuo Minami “Social Structure of Edo”, Hanawa Shobo.ＣTHasegawaNMS.Japan
160 years ago!!160 years ago!!
Complete Cure 21
Returned Home 7
No Follow-up 1
Death 8
Total 37
Internal Medicine Dr. Inoue Gentan
Ratio of Complete Cure out of Treated Patients
a little more than 0.774
本道本道
井上玄丹
井上玄丹
全快病死差引
全快病死差引
全快之分七分七
全快之分七分七
厘厘四毛余
四毛余
全快
二十一人
願下
七人
不揃
一人
病死
八人
合三十七人
Source: “Records at the Hospital” (Yojojo Kakitome), First Day of December 1831 to the Last Day of November 1832.ＣTHasegawa
NMS, Japan
ＣTHasegawaNIPH.Japan
Where this spirit has gone?
Prof. Iizuka Faculty of Engineering, Univ. of Tokyo
The Services Sector and the Healthcare Industry needs the “Toyota Way”
Customer OrientationStandardization of
Operations
Why is Japan in Recession? Productivity has not adapted to
the New (Third) Industrial Structure
The Big Paradigm Sift of Hospital Management
From Hospital Administration World of “Maestro”
“collapse of healthcare”collapse of hospitals
To Strategic Management “Toyota Way”ＣTHasegawaNMS, Japan
PARTPART 44
FutureFuture
LeadershipLeadership InfrastructureInfrastructure TechniquesTechniques
and and CasesCases
Step by Step Approach Step by Step Approach RequiredRequired
2 leaders
Dr Naruo Uehara Dr Shuhei Iida
National Demonstration
Program2000-2004
TQM Movement
with industryＣTHasegawa
NMS, Japan
ＩＴＩＴ Big Bang in 2011Big Bang in 2011
・Electric Claim of Fee・Outcome Information Released・Disease Management Matured・ＤＰＣ（Japanese ＤＲＧ）
Expanded・Ｐ４Ｐ？・One Patient One Life One Chart？Almost Almost SametimeSametime
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Saiseikai Kumamoto HospitalTQM Center Information
Management
Clinical Pathway
InfectionControl
Nutrition Support Team
Bed soreControl
RiskManagement
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Nerima General Hospital Iizuka Hospital
etc
KYT Kikenn Yochi Training
Danger Detection TrainingUsed for Industrial Hygiene Safety Consciousness DevelopmentGroup Approach Problem SolvingCase ApproachQC for Safety Version
STEPS from 5S to TQMSTEPS from 5S to TQM
5S
ProductivityImprovement
Quality & SafetyImprovement
TotalQuality
Management
Kaizen
Leadership
Organize HospitalsWork Environment Improvement
Reduce WasteGood Resource Usage
Fit to Expectation ByPatient, Employee & Standard
Integration
BPRBPRTPMTPM
POKAYOKEPOKAYOKEJITJIT
RCA FMEARCA FMEASix SigmaSix Sigma
BenchmarkingBenchmarking
1.5yrs
1.5yrs
1.5yrs
Building PositiveBuilding PositiveMind SetMind SetＣTHasegawa
NMS, Japan
Basic & SteadyBasic & Steady
Mapping out the roles of Risk Management and Patient Safety
Hospital Risk Management
Safety Management
Clinical Risk Management Support
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Could be Conflict
diagnosis
problem
treatment
resolution
history & physical
differential diagnosis definitive diagnosis
consideration of treatment optionsdiscussions and agreement
return to society
clinical examination and testingclinical examination and testing
scientific evidencescientific evidence
provision of good quality careprovision of good quality care
Clinical Risk ManagementClinical Risk Management1. Evidence-based Medicine2. Communication3. Mediation4. Teamwork5. Legal Knowledge
SupportSupport
Good Practice Good Practice ofof
This ProcessThis Process
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Our Future is
Your Future
That is Our Future
Talk to you in/for 10 years
Hospital Mortality by NightingaleHospital Mortality by Nightingale
Very HighVery High
LowLow
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