Abstract
BackgroundIn Japan, as in many other countries, several quality and safety assurance measures have been implemented since the 1990's. This has occurred in spite of cost containment efforts. Although government and hospital decision-makers demand comprehensive analysis of these activities at the hospital-wide level, there have been few studies that actually quantify them. Therefore, the aims of this study were to measure hospital-wide activities for patient safety and infection control through a systematic framework, and to identify the incremental volume of these activities implemented over the last five years.MethodsUsing the conceptual framework of incremental activity corresponding to incremental cost, we defined the scope of patient safety and infection control activities. We then drafted a questionnaire to analyze these realms. After implementing the questionnaire, we conducted several in-person interviews with managers and other staff in charge of patient safety and infection control in seven acute care teaching hospitals in Japan.ResultsAt most hospitals, nurses and clerical employees acted as the main figures in patient safety practices. The annual amount of activity ranged from 14,557 to 72,996 person-hours (per 100 beds: 6,240; per 100 staff: 3,323) across participant hospitals. Pharmacists performed more incremental activities than their proportional share. With respect to infection control activities, the annual volume ranged from 3,015 to 12,196 person-hours (per 100 beds: 1,141; per 100 staff: 613). For infection control, medical doctors and nurses tended to perform somewhat more of the duties relative to their share.ConclusionWe developed a systematic framework to quantify hospital-wide activities for patient safety and infection control. We also assessed the incremental volume of these activities in Japanese hospitals under the reimbursement containment policy. Government and hospital decision makers can benefit from this type of analytic framework and its empirical findings.
Highlights
In Japan, as in many other countries, several quality and safety assurance measures have been implemented since the 1990's
The aims of this study were to measure hospital-wide activities for patient safety and infection control through a systematic framework, and to identify the incremental volume of these activities implemented over the last five years
Development of measurement framework and questionnaire items To develop a framework that measures hospital-wide activity for patient safety and infection control, we reviewed findings from past international studies [6,7,8,9,10,11] and items of the Japan Council for Quality Health Care (JCQHC) hospital accreditation standards
Summary
In Japan, as in many other countries, several quality and safety assurance measures have been implemented since the 1990's. In Japan, as in many other countries, several quality and safety assurance activities have been executed through either voluntary actions on the part of individual hospitals, external policy, or legislative pressures [1]. This remarkable movement has resulted from an increasing (page number not for citation purposes). The other was a shocking medical accident that occurred in 1999, when an attending surgeon mistook one patient for another Despite these important developments, there have been few studies aimed at comprehensively analyzing these activities at the hospital level. These considerations are especially true in Japan, where hospitals typically underutilize critical patient safety practices
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