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Exploring the Management Model of Chinese Hospitals from the Japanese Hospital Management System

Nowadays, many hospitals advocate humanized management, which is people-oriented. Every service can only improve service quality and patient satisfaction by starting from the convenience of patients. The service concept of "people-oriented" is a significant breakthrough in hospital service and management concepts. The author combines his 7-month study at Shizuoka Prefectural General Hospital in Japan and his personal experience of visiting medical institutions such as the Shizuoka Cancer Center, to gain a close understanding of how Japanese medical services respect, understand, and care for patients, and how they provide humanized and warm services. By drawing inspiration from the humanistic management and service of Japanese hospitals, we can inspire the improvement of hospital management quality and reform and innovation.
Humanized medical environment
A warm medical atmosphere. The outpatient hall and corridors of the hospital, as well as the aisles of various consultation rooms, are adorned with various landscape paintings or calligraphy, allowing people to immerse themselves in the beauty of natural scenery and the blessings of safe recovery, forgetting the pain, tranquility, and feeling care. On the windowsills and bookcases of various medical consultation rooms, nursing desks, outpatient clinics or wards, various cute handicrafts or artificial flowers such as stuffed animals and dolls are placed, making the originally mysterious and even frightening medical environment full of warmth.
Obvious signage within the hospital. Entering the outpatient hall, there are enthusiastic and proactive medical guides from service personnel. At each intersection of the hospital, arrows and road signs of different departments are marked with different colors in all directions from the ground, walls, to the ceiling. Patients and their families who can read can easily find the consultation room or department they want to go to with the guidance of road signs. I have hardly encountered the common situation where medical staff in domestic hospitals are pulled by patients every three to five times to ask for directions.
Considerate convenience facilities. The hospital's outpatient hall, emergency room entrance, and many public places such as stairs and elevators can see neatly arranged bed type carts, wheelchairs, luggage carts, and child carts. Patients can use these transportation tools for free during the medical treatment process. In addition, the hospital has placed public rain gear and plastic bags in these public places for emergency use by patients.
Scientific architectural structure. The hospital adopts an accessible design concept to arrange a road structure that extends in all directions within the hospital. Various carts and wheelchairs can easily and smoothly reach every consultation room and ward in the hospital. Not only does it ensure the fast and convenient transportation of patients, but it also reduces the potential adverse effects of vibrations during transportation on patients. In addition to designing accessible passages and handrails specifically for people with disabilities, the hospital toilets are also equipped with nurse call devices to prevent accidents for patients during toileting.
Family style special ward. Efforts should be made to create a family oriented environment for some long-term hospitalized patients in hospitals. A public kitchen has been specially set up in some special wards to provide convenience for family members to visit and cook meals; The ward has an activity room equipped with pianos, books, magazines, and handicrafts. Patients with stable conditions can chat, relax, and even engage in small-scale singing, dancing, and other entertainment here; Even when hospitalized patients are exposed to saline, they are not "confined" to the hospital bed due to treatment. Patients can freely move around the ward with a wheeled saline rack equipped with an infusion pump. The configuration of a regular ward is a small refrigerator for each patient, a TV set, and headphones (patients can watch TV without interfering with each other), and a small safe is installed in a fixed cabinet drawer. The end-of-life care ward not only has regular ward configurations, but also has specially arranged rooms for family accommodation in the ward, providing care and support to end-of-life patients who particularly need emotional support.

Hotel style logistics services. The hospital provides each inpatient with meals designed by the dietitian and configured according to the nutritional needs of different diseases. Generally, meat and vegetables are combined with a piece of fruit. The meals are delivered in a sealed dedicated dining car, and each patient is equipped with a dedicated dining plate with a computer barcode label that matches the hospitalization code. Each ward has hot water available 24 hours a day and is also equipped with a microwave oven for patients to use at any time. Each ward and outpatient building intersection is equipped with a public telephone, and a small round table, paper, pen, and telephone number book are arranged next to the telephone. Set up daily necessities convenience stores, hair salons, bookstores, and install bank ATMs and beverage vending machines in the hospital. The hospital has established smoking areas, mobile phone rooms, and clothes drying areas. It is prohibited to use mobile phones, smoke, and hang clothes casually in the hospital, while guiding patients and their families to use them in designated places.
Harmonious doctor-patient relationship
A humanistic doctor-patient relationship. Medical staff treat patients with genuine respect and sympathy, just like their own family members. A doctor visiting a ward communicates with patients like visiting relatives and friends, observing their condition and understanding their emotions. At the same time, they politely greet their families, communicate with them, and seek cooperation. Medical staff politely use honorific names for patients and never use the patient's bed number as their title. Even when doctors and nurses take over internal shifts, they still refer to patients as Mr. or Ms. The nurse always maintains a smiling service and politely receives every patient with respect and courtesy. Medical staff should explain any medical treatment to patients in advance, demonstrating their care and respect for them everywhere. Patients' respect and trust in doctors often naturally manifest, and whether in hospitals or in society, medical staff are a profession that is respected and appreciated. This kind of mutual courtesy and respect, mutual trust and integrity between doctors and patients is a friendship and comrade relationship full of human feelings.
Comprehensive intervention nursing services. From the moment the patient enters the ward, the responsible nurse provides detailed ward introduction, hospitalization precautions, nursing service items, and other admission services, as well as an hospitalization manual. Throughout the entire hospitalization process, patients will also receive specialized guidance related to the disease. Nurses in regular wards have regular rounds twice a day, while there are regular rounds and call responses during other times. Each patient has a nursing observation record every day, which is completed by the nurse during the ward round. The nurse is required to be familiar with the patient in charge, and usually the head nurse and responsible nurse in the ward can remember the name of each patient. In addition to medical care, nursing services also provide a large amount of daily care, such as haircuts, shampoos, body rubs, and showers for patients with mobility difficulties, and providing a horizontal shower machine for patients who are seriously ill and bedridden, elderly, and weak; Provide accompanying care for patients undergoing various instrument examinations, such as undergoing endoscopic examinations with a dedicated escort. Cover the patient with blankets during the examination and take care of their recovery and rest after the examination. When a patient is discharged from the hospital, the nurse should provide guidance on discharge to the patient.
A team of clerks with special responsibilities. In addition to professional medical services, the ward also has a team of clerks with cultural qualities, mainly young women. The job responsibilities of a clerk are to provide assistance beyond medical services, such as assisting in handling patient admission and discharge procedures, receiving visitors, answering phone calls, and other daily affairs of the department. The biggest characteristic of a clerk's job is to accompany patients and serve them at any time. They transport patients to the medical consultation or examination room, and have friendly conversations with patients to comfort their daily life issues. Good words are better than good medicine, so the assistance of the clerk sometimes has a physical and mental therapeutic effect that medical methods cannot achieve, alleviating the patient's tension and relieving the worries of the patient's family.
A standardized and orderly medical appointment system. In Japan, known for its high work pressure and fast pace of life, the concept of time is also reflected in medical services. Both outpatient and inpatient appointments have a standardized and comprehensive appointment system. As long as patients seek medical attention on time, the hospital ensures that patients can see the agreed doctor at the agreed time. The appointment system greatly reduces the waiting time consumed by patients outside of diagnosis and treatment, and also greatly optimizes the hospital's medical environment, allowing patients to enjoy high-quality services in both time and environment.
Respect the rights of patients and protect personal privacy. Both the patient list in the doctor's office and the bedside card in the ward only have the patient's name and not the patient's name. What kind of illness a patient suffers from and the severity of the illness are kept confidential as patient privacy, and hospitals and medical staff have no right to disclose it. During the medical process, any examination that exposes the patient's body must be isolated from unrelated personnel (usually by pulling up the curtain). Even in front of the medical staff conducting the examination, efforts should be made to reduce the exposure area of the patient's body. For example, during colonoscopy, the hospital will provide disposable pants with open crotch. Patients have the right to autonomy in the inpatient ward. They can paste their favorite pictures or family photos on the walls of the ward, and place objects such as dolls and toy dogs on the tabletops and cabinets of the ward. Adults are no exception, and daily necessities are also freely arranged according to the patient's wishes and convenience.
Comprehensive medical services
Advanced medical equipment. First-class medical technical personnel and first-class medical service attitude need to achieve first-class medical quality and service effectiveness on the first-class medical instrument and equipment platform. Japan's advanced technological level has enabled the most advanced medical equipment to be first applied in clinical practice, reflecting humanized medical services from the practical results of early relief of patient pain. Japan's strong economic foundation enables medical institutions to have sufficient medical equipment resources, ensuring that everyone enjoys first-class medical services. For example, in Japan, endoscopes are used for each patient, and other contact devices are also disposable. Significantly reducing cross infection in the hospital and relieving patients' concerns. Patient oriented humanized services are demonstrated as a strong technological and material foundation.
Networked information management. The hospital's networked information management system greatly reduces the incidence of errors and accidents. The hospital establishes a unique information code for each patient. From the moment the patient is admitted, they wear a "patient identification tape" on their wrist with their name, hospitalization number, and computer barcode. Before any examination or treatment, medical staff will double check the patient's name and the "identification tape" on their wrist. In the process of medical services, hospitals design various blood and fecal test forms (including test tubes), special examination forms (such as pathology forms), and clinical treatment forms (such as oral medication, intravenous infusion, and blood transfusion) as unique computer barcode documents for patients. Medical staff not only rely on manual double checking of patient names, but also add a network verification program through computer card swiping, and even encounter elderly and weak patients with hearing impairment and language difficulties, Not afraid of identity verification issues. The portable laptops equipped by medical staff can not only input patient information into the network information database at any time, update electronic medical records at any time, but also swipe and verify computer barcodes at any time. The injection syringe is labeled with a computer barcode with the patient's name and medication name, and various infusion bottles that have already been injected with medication and transfusion bags that are ready for transfusion are also labeled with the patient's name and computer barcode. The construction of hardware such as computers and networks has built a convenient and accurate patient information management platform for humanized medical services.

Strict medical quality control and accident prevention
Medical quality is the lifeline of hospitals and also the lifeline of patients. Only with medical quality and medical safety can hospitals provide humanized services and patients enjoy humanized services. In Japan, the Hospital Quality Management Committee assumes the responsibility of medical quality control. The committee shall revise the standardized diagnosis and treatment steps for various common diseases according to disciplinary organization, including diagnostic procedures, precautions, standardized medication, etc; Doctors in various departments strictly follow the "manual" provided by the Quality Management Committee for diagnosis and treatment operations. In addition to strictly following the quality management diagnosis and treatment procedures by medical staff, strict management is implemented for drugs, especially anesthetics, in the ward. Each ward is also equipped with a pharmacist responsible for or assisting in the quality supervision and management of drugs. While strengthening quality control, hospitals do not obscure the possibility of medical accidents. The hospital has a medical safety room specifically responsible for accidents (or errors), prevention of hospital infections, safe blood transfusion strategies, and rational use of antibiotics. Each ward has dedicated personnel responsible for registering various major and minor errors. The medical safety room regularly summarizes and analyzes the results on a monthly and annual basis, and provides feedback to medical staff to propose new preventive measures, continuously preventing accidents from happening through prevention systems and prevention systems, Provide humanized and reassuring services to patients.
Transforming the medical environment and creating a warm atmosphere of humanistic care
The humanistic neon enclosure, hospital signage, convenient facilities, accessible buildings, and star rated services all create a humanized medical environment, which directly affects the diagnosis and treatment effectiveness and medical mood of patients. From the construction of Japanese humanized medical environment, we are inspired to pay attention to the importance of humanistic care and service concepts in the construction of hospital environment. We need to consider creating a convenient and comfortable medical environment for patients while building taller, larger, and more beautiful large hospitals. Create accessible passages to provide convenience for people with disabilities and patients with difficulty walking. Reasonably designing the medical treatment process not only facilitates patient consultation, but also helps to save time for critically ill patients. Implement optimized and beautified "environmental engineering" to achieve flowers, grass, and greenery. The consultation room and ward should be designed as indoor homes and outdoor gardens, creating a warm medical environment. Medical staff should have a generous and dignified appearance, a warm and sincere attitude, and a friendly and smiling service to alleviate patients' nervousness, alleviate the pain and psychological pressure caused by the disease.
Change doctor-patient relationship, respect patient rights and personal privacy
The rights of patients include equal medical treatment, disease awareness, information, and privacy protection. In the process of diagnosis and treatment, although medical personnel are in an active dominant position in technology, they need to avoid a sense of superiority. Patients are in a passive obedient position in terms of knowledge, so the hospital must supervise whether medical personnel uphold patient rights in their services.
Hospitals and doctors should establish more institutionalized communication with patients and their families, accurately introduce the condition to patients, and patiently explain medical information; Discuss with patients the pros and cons of different treatment options (such as surgical and non surgical treatment) and the likelihood of different outcomes; From the perspective of patients, consider the time, cost, and family impact required for disease treatment and rehabilitation, and help patients make the most suitable choices based on their own condition and family background. Only by establishing a cooperative relationship full of sincerity and mutual respect between doctors and patients can patients feel at ease and doctors increase their confidence, which is the best embodiment of humanized medical services.
Hospitals and doctors need to change the "exposed" medical practice of "one person diagnosis and treatment, multiple people watching". Examinations of exposed bodies should try to minimize exposure by covering patients with curtains or screens. Strictly abide by professional ethics and confidentiality for illnesses involving personal privacy. In medical activities, it is necessary to change the impolite habit of calling the patient's bed number instead of the patient's name. We should respect the personal habits of patients, and the bedside table and cabinet in the ward should allow patients to freely place daily necessities. We should change the military camp style requirement of "one bottle and one cup at the bedside" fixed placement in the past, and prioritize patient comfort, convenience, and benefit for recovery.
Improve service philosophy and establish a people-oriented mindset
Comparing the quality of medical services in Chinese and Japanese cities, we do not lack "hard power", but rather "soft power". Especially in the economically developed eastern region, the difficulty in fierce competition in the medical market is no longer the construction of hardware, but the improvement of software. Whoever wins patients wins the market, and whoever wins the development of the hospital. Hospitals must establish the fundamental purpose of putting people first, and regard patient satisfaction as the management philosophy and practice guidelines.
On the basis of continuously improving hardware equipment, hospitals should continuously create new measures for convenience, establish networked management, simplify medical procedures, increase service windows, and shorten waiting times. Reasonably layout the diagnosis and treatment process in the outpatient department, use human resources and physical facilities such as medical guides and guide signs, and maximize the convenience of patients. Promote appointment outpatient services and establish smooth green channels.
Hospitals should embody people-oriented approach in environmental construction and service support. The hall and consultation room should be carefully decorated with civilized blessing slogans, allowing patients to experience a friendly, warm, and valued atmosphere in the hospital, and allowing medical staff to unconsciously cultivate professional habits of respecting, helping, and facilitating patients. The hospital provides free convenient services such as wheelchairs, stretchers, and boiling water in public places. New or renovated hospitals must consider logistics service projects, such as 24-hour hot water supply, establishment of small supermarkets, self-service bookstores, automatic safes, hair salons, and photo studios; The ward has activity rooms and patient clubs, children's playgrounds in pediatrics, family delivery rooms in obstetrics, and family rooms for end-of-life cancer patients.
Hospitals should strive to develop innovative, high-tech, and cutting-edge medical research while vigorously developing and introducing various minimally invasive, painless, practical, and advanced clinical technologies, such as painless abortion, painless gastroscopy (colonoscopy), and new laparoscopic surgeries, to provide high-quality and humanized medical services to patients with first-class technology.
Hospitals should strengthen professional ethics and knowledge training for their workforce based on people-oriented and patient satisfaction. Especially, employees should be organized to learn emerging edge disciplines such as psychology, sociology, and ethics to adapt to the new medical model and comprehensively meet the needs of patients. Win the trust of patients, win the praise of society, and gain a broader space for hospital development.

Background in domestic rehabilitation medicine:
1. According to the clinical efficacy of early rehabilitation treatment for critically ill patients, through comparative experiments, early rehabilitation treatment for critically ill patients can reduce the incidence of pressure ulcers, mortality, and delirium, shorten mechanical ventilation time, ICU hospitalization time, and thus reduce hospitalization costs. From the data, we can clearly see that rehabilitation is very necessary, but why is it still often not mentioned in China's current rehabilitation? Let's continue to look further.
2. From the perspective of the people, there is still room for improvement in their understanding of rehabilitation medicine. The inherent concept of "emphasizing clinical practice and neglecting rehabilitation" has led to a lack of sufficient understanding of rehabilitation medicine, making it unable to be effectively utilized. The current understanding of rehabilitation medicine in society is mainly manifested as
(1) Not actively seeking medical attention due to the patient's weak understanding of the rehabilitation effect;
(2) The patient waited for the pain to heal themselves and missed the best recovery period;
(3) Clinicians have insufficient understanding of rehabilitation effects and do not guide patients to undergo rehabilitation after clinical treatment;
(4) The patient is willing to recover, but due to limitations such as medical insurance accessibility and payment pain points, the entire rehabilitation cycle was ultimately not executed or completed.

3. Insufficient supply of rehabilitation medical services: number of institutions, number of beds, and employees;
The Outline of the National Medical and Health Service System Plan (2015-2020) clearly states that bed allocation needs to be tilted towards nursing and rehabilitation beds in grassroots medical institutions, which has promoted the increase of rehabilitation subject beds. As of 2020, there were 246907 beds in the rehabilitation medicine department of Chinese hospitals, accounting for 3.5% of the total number of beds. However, there is still a gap of 1.5% between the 5% standard required by the "Basic Standards for Rehabilitation Medicine in General Hospitals (Trial)" and it needs to be filled. In addition, the proportion of rehabilitation medicine departments in tertiary and secondary comprehensive hospitals is 74.36% and 18.23% respectively, with gaps concentrated in secondary hospitals. The rehabilitation medicine departments in comprehensive hospitals have shortcomings in terms of department setting and building area. From a regional perspective, there are significant regional differences in the allocation of rehabilitation wards nationwide. There are more rehabilitation wards in economically developed areas than in underdeveloped areas, and the allocation of rehabilitation wards needs to be further balanced.

The failure of China's rehabilitation industry to usher in an outbreak is closely related to the supply of talent. According to the China Health Talent Network, the scale of various rehabilitation professional and technical talents in China in the future is around 1 million, with a current total of around 500000. Among them, there were 11015 registered rehabilitation therapists in 2017, which is unimaginable. The shortage of talent supply is mainly related to education. There are only 128 undergraduate majors related to rehabilitation therapy and sports rehabilitation in Chinese universities, with 219 in the United States, 280 in Germany, and 241 in Japan. In terms of master's and doctoral degree education, speech therapy experts are even more scarce in China.
With the rapid aging of the population and the increasing number of disabled patients, it is urgent to cultivate the awareness of national rehabilitation. Communities, medical institutions, mass media, governments, and other sectors need to work together to create a social atmosphere for national rehabilitation and raise awareness of national rehabilitation. This is the primary task of promoting the development of rehabilitation medical services.
How to develop?
1、 Advance the development concept of rehabilitation management
1. At present, the development of the industry is based on the International Classification of Functionality, Disability, and Health (ICF) signed by the World Health Organization as the basic concept of rehabilitation medicine. It proposes the concept of "early", "proactive", and "comprehensive" rehabilitation, and clearly recognizes the importance of "early detection", "early diagnosis", and "early intervention". "proactive" has shifted from passive training in the past to emphasizing stimulating patients' initiative and enthusiasm, and encouraging patients to actively train, Enhance patients' confidence in returning to society. Comprehensive rehabilitation should be carried out from the beginning of the injury and implemented throughout. Rehabilitation equipment is the foundation, systematic education is the means, and health intervention is the key, with the ultimate goal of achieving effective "health promotion".
2. We propose a department development strategy of "rehabilitation, education, and research" with "rehabilitation management" as the cornerstone, "treatment of dysfunction" as the core, "data-driven" as the guide, and "disciplinary construction" as the direction. Through improvement, compensation, and improvement of functional quality, we promote the integrated development of "evaluation, treatment, management, and promotion" through the process of the biological psychological social model. Realize the transformation from "centered on rehabilitation of obstacles" to "centered on comprehensive health".
2、 Create a development path for rehabilitation business
Construction concept:
Rehabilitation Center (Basic), Simulated Life Center, Psychological Rehabilitation Center, Co creation Center (Upgrade), Rehabilitation Business Information Management System, and Rehabilitation Information Integration Platform
1. Utilize resources managed by a comprehensive hospital to collaborate with various departments in rehabilitation management activities.
2. As the checkpoint moves forward, rehabilitation medical institutions gradually penetrate into communities, streets, schools and other living places, and rehabilitation concepts and related assistance also break away from the walls of the medical environment and become closer to people's daily lives.
3. People with physical and mental disabilities are the main audience group, but in reality, they often include sub healthy and healthy populations. The psychological rehabilitation center needs to be equipped with special treatment equipment such as transcranial magnetic stimulation, biofeedback, cognitive function treatment, immersion experience, etc., to provide comprehensive psychological diagnosis and treatment services. Establish a psychological assistance hotline, conduct in-depth publicity, mobilize and guide the public to care for mental health, gradually increase awareness of the importance of mental and psychological health rehabilitation, master basic stress regulation methods, achieve early detection and intervention, reduce and eliminate the sense of shame, and let the concept of "individuals are the first responsible person for their own mental health" deeply rooted in people's hearts.
4. Develop a rehabilitation business information management system for various rehabilitation institutions that can be connected to various HIS systems, and a network platform that can integrate rehabilitation service information of various rehabilitation institutions. While conducting online services and communication, establish an information database.

3、 The necessity of integrating rehabilitation medicine with social responsibility
Health is an inevitable requirement for promoting comprehensive human development, a fundamental condition for economic and social development, an important symbol of national prosperity and national prosperity, and a common pursuit of the general public. As the main body of the medical and health service system, public hospitals should play a major role in comprehensively implementing the new era health and health work policies, and implementing the Healthy China strategy, continuously meeting the multi-level and diversified medical and health service needs of the people.
In addition to macro policies, the country also gave guidance on specific implementation and strategies. At the beginning of July 2021, the NDRC official website news, the National Development and Reform Commission, the National Health Commission, the National Administration of Traditional Chinese Medicine and the National Bureau of Disease Control and Prevention jointly prepared the "Fourteenth Five Year Plan" Quality and Efficient Medical and Health Service System Construction Implementation Plan, which clearly defined the construction goals and improved China's health services for women and children, rehabilitation care Shortcomings in mental health and mental health services, occupational disease prevention and control, etc. (Four departments jointly issued a document: These hospitals will be transformed into rehabilitation institutions!)
Rehabilitation medicine has played an important medical, economic, and social role in the medical system. From a clinical perspective, rehabilitation medicine is a fourth type of medicine that ranks alongside preventive medicine, clinical medicine, and healthcare medicine. It plays an important role in the medical system - making up for the shortcomings of clinical medicine. Rehabilitation medicine is committed to eliminating and reducing human dysfunction, making up for and rebuilding human functional deficiencies, Efforts should be made to improve and enhance various aspects of human functions, including the prevention, diagnosis, evaluation, treatment, training, and management of functional impairments. Although medication and surgical treatment can directly treat pain, they cannot achieve functional recovery and must rely on rehabilitation medicine.
Medical value: Rehabilitation helps patients repair psychological and physical trauma, restore normal function, quality of life, and work ability. Patients receiving rehabilitation treatment can significantly improve their level of functional recovery and quality of life.
Economic value: Rehabilitation therapy can accelerate physical function recovery, reduce recurrence rate, reduce complications, and save overall treatment costs. After receiving rehabilitation treatment, the total cost significantly decreased and showed a monthly decreasing trend. Therefore, rehabilitation treatment is in line with the trend of controlling medical insurance costs.

Conclusion:
In response to the current development status of China's rehabilitation medical industry, combined with future demand and supply forecasts, China's rehabilitation medical industry will present five major development trends, namely the need for community rehabilitation, the trend of remote rehabilitation, the great potential of high-end rehabilitation, the obvious advantages of intelligent rehabilitation, and clinical medicine driving rehabilitation development.
Although rehabilitation medicine in China is accelerating its development, it is still in a relatively early stage, and there is a certain gap compared to developed countries in various aspects such as public awareness of rehabilitation, supply of rehabilitation medicine talents, and total rehabilitation resources. But we also need to see that with the development of society and economy, the continuous expansion of the middle class group, and the increasing awareness of people's rehabilitation, the development of rehabilitation medicine will be increasingly valued, and the future development space of the rehabilitation medical market will continue to expand.

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