Gaia Series 21 : Revitalize The Hospital

This week, we turn the spotlight on the healthcare sector, paying special attention to how hospitals have tackled manpower issues. First up is the Otsu Municipal Hospital in Otsu City, Shiga Prefecture. It has 30 departments and approximately 400 beds and serves as the area’s flagship hospital. However, in recent years its reputation took a beating over the management’s alleged “power harassment”. Several doctors resigned and many patients stopped coming to the hospital, which also led to the hospital suffering a huge deficit, the largest in its history.

The debacle was set off when surgeons from Kyoto University accused the chairman of Otsu Municipal Hospital of forcing them to reduce and transfer personnel without explanation. The problem led to 32 doctors announcing their resignation. The chairman, who is from Kyoto Prefectural University of Medicine, then resigned in early 2022. Akihiko Hino, who graduated from the same university years ago, was then appointed in April 2022 as the new hospital director and was tasked with turning things around. He is a neurosurgeon who has performed thousands of operations in nearly 30 years.

In attempting to transform the hospital, Mr Hino had to tackle the dark reality of academic cliques in the medical field. Among large flagship hospitals, there are many that are affiliated with certain universities. For example, many doctors from Kyoto Prefectural University of Medicine work at Otsu Municipal Hospital. Positions like the head of each hospital department are controlled by university professors. So in order to become the head of department, a person needs to get professors from the university one graduated from to “assign” them to that post. Mr Hino however had nothing to do with such academic cliques. 

As a result of the debacle, all five full-time neurosurgeons who were from Kyoto University resigned from the hospital. They were sent by Kyoto University to the Otsu Red Cross Hospital. Mr Hino and two part-time doctors had to run the department at Otsu Municipal Hospital, on top of doing his duties as hospital director. Despite this, Mr Hino managed to persuade 10 out of the 32 doctors who resigned to reconsider their decision. Two full-time doctors from the Radiology Department decided to stay on, as did eight full-time doctors from the Anaesthesiology Department. 

In April this year, Otsu Municipal Hospital’s fiscal year started and 63 new recruits were hired, out of which 31 were doctors. The management also announced that the hospital had incurred a deficit of 1.5 billion yen over the previous fiscal year, the largest in its history. The hospital had lost many patients because of the alleged “power harassment” debacle and its hospital bed occupancy rate was 79.5 per cent, a decline of nearly 10 per cent from the previous fiscal year. Otsu Municipal Hospital is a Regional Medical Care Support Hospital, where local primary care doctors refer their patients to for detailed exams and specialised treatment. But the hospital has also been getting fewer referrals, which has also led to more losses. 

Mr Hino then got the hospital involved in a new “Express Outpatient” project. One of the first to benefit was Patient A, who was diagnosed with colorectal cancer in end-May. This was putting pressure on his intestines, making it dangerous for him. While one usually has to wait a few weeks or months for the surgery to be done, Patient A was operated on eight days after his first visit. His doctor was Mr Wataru Osumi, a gastrointestinal surgeon, who was hired in April 2022 and who devised the Express Outpatient initiative after talking to Mr Hino. Otsu Municipal Hospital was one of the first to implement the newest Da Vinci model for robotic surgery. Cameras and forceps attached to robotic arms are inserted into little holes opened in the body. By using a machine that can bend more freely than human hands, laparoscopic procedures can be done with more precision and less bleeding. Patient A’s surgery took more than six hours and was a success.

We move over to Iizuka Hospital in Iizuka City, Fukuoka Prefecture. More than 1,000 nurses work at this hospital. The hospital is said to be the first in Japan to implement a new style of nursing called the Cellular Nursing System. It was introduced about 10 years ago by head nurse Yuka Moriyama. She had first seen it being implemented in a hospital in Seattle in 2011. She noticed there were no nurses at the staff station because they were by their patient’s bedside instead. This way, the nurses were not only treating illnesses but also supporting patients emotionally. The nurses also felt greater job satisfaction and a sense of fulfilment. 

So Ms Moriyama decided to use the same system at Iizuka Hospital. Instead of staying at the nurses’ station, the nurses are assigned to hospital rooms and stationed there with the patients. Each nurse is in charge of about four patients. They are thus able to focus on individualised care, observe symptoms more closely and provide high-quality nursing care. This has led to a decrease in cases of bedsores and falls among patients, for example. 

Another hospital which has taken steps to improve the work environment of nurses is the Ebina General Hospital in Ebina City, Kanagawa. The staff station used to be very hectic with some nurses taking care of up to 12 patients a day. The nurses were not able to see the patients that well because of certain blind spots such as pillars. So this year, a “triangle” ward was built by Shimizu Corporation. There is a staff station at each stop, at every corner. So if one stands by the edge, one can see where the patients are and what they are doing. The nurses can see the patients clearly without any obstructions and this allows them to respond to any incident promptly.

Tips:

1)    Otsu Municipal Hospital has implemented an “Express Outpatient” initiative to speed up the surgery waiting time for certain patients
2)    Ebina General Hospital’s “triangle” ward has helped nurses respond to patients more quickly