Tokyo Metropolitan Matsuzawa Hospital is celebrating its third New Year since moving to a new medical care building. How are you all celebrating the New Year? Following on from last year, in 2015, Matsuzawa Hospital will continue to work towards becoming a “hospital chosen by patients.”
When I took over management of this hospital in July 2012, I set and started working towards the goal of “not turning down requests from private medical institutions”. This was, so to speak, a problem of numbers. It is not difficult to evaluate “whether or not a request is accepted.” In 2013, the bed occupancy rate was 89.6% (up 6.7% from the previous year), 798 patients were hospitalized per day (up 60 patients from the previous year), the mean length of stay was 86.4 days (down 6.9 days from the previous year), and there were 411 outpatients (up 42 patients from the previous year). These figures were achieved as a result of Matsuzawa Hospital continuing to accept hospitalization requests and outpatient referrals from 2012 to 2013. Incidentally, during this time, our consultation waiting time became the shortest of all 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 a “hospital chosen by patients?” The quality of medical care is often cited, which is not as easy to evaluate objectively as economic indicators are, such as bed occupancy rate. Evaluating the quality of medical care is particularly difficult in psychiatric departments 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 answered that they were “satisfied” with the 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% to be pending opinions, the proportion of patients who feel actively “satisfied” with their inpatient treatment account for no more than slightly over 20% of the total. This reveals a large disparity between the level of satisfaction of family members and the level of satisfaction of patients. Many family members who struggle with the psychiatric symptoms of patients are thankful simply for the inpatient treatment provided to these patients, whereas the patients may be forced into involuntary hospitalization, a restricted lifestyle, and a state of medication and thus have difficulty saying they are “satisfied.” The fact that patient’s wishes and the wishes of family members or those around them are not necessarily consistent is one of the factors that make evaluating the quality of psychiatric care difficult.
The Organisation for Economic Co-operation and Development (OECD) identifies the lack of investigation into indicators for evaluating the quality of medical care as the underlying problem of Japanese psychiatric care. The Japan Municipal Hospital Association has started making attempts to publish indicators for evaluating the quality of medical care with the participation of psychiatric hospitals. Matsuzawa Hospital is not presently participating in this program. However, since 2014, our hospital has been publishing reports of incidents and accidents that occur within the hospital and information on patient isolation and restraint, etc. Moreover, starting this year, we will be sequentially publishing the monthly surveys of discharged patients, the one-day surveys of all patients that were hospitalized and their family members (conducted since 2013), and the results of surveys of outpatients on our homepage.
The length of stay, number of patients admitted and discharged, number of initial outpatient visits, number of visits to the outpatient clinic and other measures published as management indicators may serve to evaluate the quality of medical care depending on perspective. The performance of the Pharmacy Department and Nutrition Department and the rate of social reintegration from daycare may also become important indicators.
A third-party evaluation committee, which has been evaluating 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 wards of Matsuzawa Hospital. The aim of this is to receive a third-party evaluation in conjunction with surveys of patients and their family members.
In addition to the above initiatives implemented up to the present, in 2015 we will launch an investigation to select evaluation indicators by establishing a committee for evaluating the quality of medical care within our hospital. Investigating specific indicators is an important process when considering problems such as what denotes the “quality of medical care.” This year, we, the hospital staff, intend to work hard together to provide even better quality psychiatric care to patients suffering from mental illness.