CDIMIntroduction
Japan's medical care delivery system is currently supported by overworked medical personnel such as doctors. For this reason, shortening the working hours of medical workers such as doctors has become an urgent issue.
From April 2024, a new system for work style reform for doctors will start, and it has been agreed that the upper limit of overtime and holiday working hours for doctors will be 960 hours or less per year, just like for general workers.
Currently, many medical institutions are starting to review their labor management methods, review and reduce work, and shift tasks in order to implement such reforms in the way doctors work. The situation varies depending on the hospital.
Therefore, this time, we interviewed Dr. Shuichi Osawa, the chairman of Naowa-kai Heisei Seki Hospital, a medical corporation in Katsushika-ku, Tokyo, who has been working on reforming the way doctors work even before the idea of reforming the way doctors work began, and is seeing results. We asked him about the background behind the need for reforming the way doctors work, the details and effects of our hospital's efforts to reform the way doctors work, and his advice for medical institutions that are currently working on reforming the way doctors work. The content will be serialized in four parts.
Chiwakai Medical Corporation Heisei Seki HospitalChairmanProfile of Professor Shuichi Osawa
Graduated from Nippon Medical School in 1991 and joined the Department of Urology, Nippon Medical School Hospital. After that, he joined the hospital when it opened in 2002. He assumed his current position after serving as director of the urology department, vice director, and director.
(4) Efforts to reform the way doctors work in the future at Heisei Seki Hospital
Q. What kind of further work style reform measures are you considering at Heisei Seki Hospital in the future?
Physician administrative assistants, emergency medical technicians, and nurses efficiently perform a variety of tasks within the hospital, including task shifting for physician duties. On the other hand, there are still some occupations in which there is room to shift the work of doctors and improve the efficiency of their own work. Examples include clinical engineers and radiology technicians. They are currently doing their best, but I would like them to take on a broader range of duties. I want them to find work that they can do from the perspective of the hospital as a whole, and I also want them to consider streamlining existing work. I'm always talking to them about doing whatever I can.
We are also considering further revisions to the work of doctors themselves. For example, a doctor's explanation to a patient's family. In the past, if a patient's family could only visit the hospital on Sundays, some doctors would work on Sundays to accommodate the patient's convenience, but we are trying to reduce this practice. Due to the coronavirus restrictions on visits by patients' families, we have increased the number of opportunities to provide explanations to patients' families over the phone. Although the coronavirus situation has calmed down a little now, we continue to take the stance that patient explanations can be conducted over the phone to reduce the burden on doctors.
We are also reviewing the attending physician system. Rather than having one doctor assigned to each patient, we work as a team. Of course, there is a doctor who serves as the core of medical care for each patient, but if, for example, a patient suddenly becomes ill in the middle of the night, other doctors are available to respond. I hope to reduce the responsibility and pressure of doctors.
We also plan to encourage improvements in doctors' working hours. For example, when it comes to being on duty, I have the opportunity to be on duty several times a month. However, rules must be created to prevent continuous shifts from being on duty. For example, I feel that there is a need to create a hospital rule that requires employees to go home after a certain number of working hours.
Recently, there has been discussion about the line between doctors' self-improvement and work. This is also a very difficult problem. However, I think the important thing is to clearly delineate the line between self-improvement and work in the work regulations. For example, clarifying regulations such as ``Activities related to ○○ are considered self-improvement, and other activities are considered work.''
However, if it becomes too detailed, it will be difficult to operate, so we will simplify the rules a little more and make the rules such as ``While the electronic medical record is open, it is considered work, and activities when the electronic medical record is closed'' are considered self-improvement. I think it would be best for everyone in the medical association to consult and make decisions.
(5) Advice to medical institutions that are working on reforming the way doctors work
Q.Thank you. Lastly, do you have any advice for other medical institutions?
One of the difficulties in implementing work style reform is the size of the hospital. Because our hospital is a relatively medium-sized hospital, there is no doubt that it was easy to communicate among doctors, and it was also easy to build trust with other professions. For large medical institutions, the hurdles for implementing work style reforms will be higher than for small and medium-sized hospitals.
Naturally, a large hospital will have a large number of doctors. Since there are as many different ways of thinking as there are doctors, the way people think about work style reform itself also differs from person to person. Listening to each person's opinion and trying to convince them will take time and may cause the reform to stall.
Also, if you are a hospital with 1,000 doctors, for example, and you decide to shift tasks to physician office assistants, how many assistants should you hire? Since it is difficult to see the workload of each doctor, it is also difficult to predict specific effects. Even if 100 doctor office assistants were hired, only 100 would work for 1,000 doctors. If there is no such person, the work that can be entrusted to them will be limited. On the other hand, even if you try to hire more than 100 medical office workers, there are concerns that management efficiency will deteriorate from the perspective of personnel costs.
Additionally, there are challenges unique to large hospitals in terms of building trust with other professions.
It goes without saying that doctors are large, but so are nurses and other departments. Doctors may be able to build relationships of trust with nurses and other people with whom they have personal connections, but if a department as a whole shifts some of its work, some doctors may object to the task shift due to concerns. This will lead to dissatisfaction on the part of the shiftee as to why it is necessary to take on the work, and in the end, a relationship of trust will not be built, resulting in unsatisfactory task shifts and work style reforms. It's easy to get into situations.
In this way, large hospitals have some aspects that make it difficult to implement work style reforms due to their size. Even under such circumstances, the only way to implement work style reform is to implement it from the top down. The top management has to give the order and show the reasons for carrying out work style reform and the actual policy. The top management himself emphasizes to the staff the need to improve the efficiency of hospital management and correct the working environment of each staff member, and carefully explains to the staff how to build a better hospital. I think this will foster a sense of ambition and compassion for each other to improve their workplaces.
There are no shortcuts to work style reform. It is necessary to steadily create a common understanding within the hospital.
By the way, if I were to implement work style reform as the head of a large hospital, I would start by increasing the number of people I work with. As I mentioned earlier, if there are 1,000 doctors, it is difficult to convey your ideas to all 1,000 doctors and get them to agree. Therefore, make friends and have them convey your message to you. Specifically, I would like to ask the doctors who are at the top of the practice, such as the medical director, to agree with my ideas, and to convey my message to the lower levels as my colleagues.
The larger the organization, the more important it is to get the message across. We will patiently communicate this information, and once the foundation for work style reform is established, we will promote the reform from the top down, together with the clinical directors who are responsible for the actual work. I think we will work hard to create a good hospital while carefully checking the degree to which we have built relationships of trust within our departments and, by extension, within the hospital as a whole. We hope for your reference.
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Written by: Kohei Yamashita / Hiroyoshi Takahashi
Kohei Yamashita (Consultant, CDI Medical Co., Ltd.)
Graduated from the School of Human Sciences, Waseda University, and completed the master's course at the Graduate School of Human Sciences, Waseda University.
After working for a medical device manufacturer, a consulting company for medical institutions, and a medical venture company, he has reached the present.
Hiroyoshi Takahashi (CDI Medical Co., Ltd. Consultant)
Graduated from Keio University Faculty of Commerce, Completed Graduate School of Business Administration (MBA)
Worked at Corporate Direction Co., Ltd., a manufacturer of medical heavy electrical equipment, until now.