Challenges ahead in 2015


Tokyo Metropolitan Matsuzawa Hospital is celebrating its third New Year since moving to a new facility. How are you all celebrating the New Year?

Following on from last year, in 2015, Matsuzawa Hospital will continue its efforts to become “patients’ first-choice hospital.”

When I took over management of this hospital in July 2012, I started working towards the goal I set of not turning down requests from private medical institutions. This was, so to speak, a problem of numbers. It is not difficult to see whether or not a request was accepted. In 2013, the bed occupancy rate was 89.6% (up by 6.7% from the previous year), 798 patients were hospitalized per day (up by 60 patients from the previous year), the mean length of stay was 86.4 days (down by 6.9 days from the previous year), and there were 411 outpatients (up by 42 patients from the previous year). These figures were achieved as a result of Matsuzawa Hospital’s continuing to accept hospitalization requests and outpatient referrals from 2012 to 2013. Incidentally, during this period, our consultation waiting time became the shortest of all the municipal hospitals, thanks to the introduction of an appointment scheduling system for ambulatory care.

However, how can we determine whether or not our hospital has become “patients’ first-choice hospital”? The quality of medical care, such as the bed occupancy rate, which is not as easy to evaluate objectively as an economic indicator, is often cited. Evaluating the quality of medical care is particularly difficult in the psychiatric department for a variety of reasons. In a monthly survey of discharged patients conducted by Matsuzawa Hospital, 74.5% of family members and 52.3% of patients responded that they were “satisfied” with their hospitalization experience. The overall recovery rate was 58.6%, and the response rate of patients was 40.4%. Therefore, if we consider the remaining 60% of patients to be in the undecided category, patients who felt clearly satisfied with their inpatient treatment accounted for no more than slightly over 20% of the total figure. This reveals a large disparity between the level of satisfaction among family members and the level of satisfaction among patients. Many family members who struggle with the psychiatric symptoms of patients are thankful for any inpatient treatment provided, whereas the patients themselves may have been forced into involuntary hospitalization, to live a restricted lifestyle, and to be in fog of continual medication that makes it difficult for them to decide whether their treatment is really satisfactory. The fact that patients’ wishes and those of their family and friends do not necessarily agree is one of the factors rendering the evaluation of the quality of psychiatric care difficult.

The Organisation for Economic Co-operation and Development (OECD) has identified the lack of research in the indicators of medical care quality as one of the underlying problems in Japanese psychiatric care. As a result, the Japan Municipal Hospital Association has begun making attempts to publish indicators for evaluating the quality of medical care with the cooperation of psychiatric hospitals. Matsuzawa Hospital is not presently participating in this program. However, since 2014, we have been publishing reports on incidents and accidents occurring within the hospital and information on patient isolation, restraints, etc. Moreover, starting this year, we will be sequentially publishing the monthly surveys of discharged patients, including the one-day surveys of all the patients who were hospitalized as well as their family (conducted since 2013), and the results of outpatient surveys on our hospital website.

The length of stay, number of patients admitted and discharged, number of initial outpatient visits, number of visits to the outpatient clinic, and other metrics identified as management indicators may help us to evaluate the quality of medical care from various perspectives. The performance of the Pharmacy Department and Nutrition Department and the rate of social reintegration via daycare may also serve as important indicators.

A third-party evaluation committee, which has been assessing our work since 2013, also plays a crucial role. This committee is composed of doctors, nurses, and lawyers from outside the hospital who inspect and evaluate the Matsuzawa Hospital wards. Their aim is to provide a third-party evaluation that can be used in conjunction with our own surveys of patients and their family members.

In addition to these initiatives, which are still in effect, in 2015 we will launch an investigation into selected evaluation indicators by establishing a committee to assess the quality of medical care at our hospital. Investigating specific indicators is an important process when considering various problems, including the question of what specifically defines the quality of medical care. This year, we intend to work hard to provide even better quality psychiatric care to patients suffering from mental illness.