ASOURCE Times

Maintaining a consistent quality of medical care
Originally developed quality indicators for home medical care

In 2020, at the start of the COVID-19 pandemic, I opened "Home Clinic Meguro," and currently operate enhanced home medical support clinics in Meguro and Nakano Wards in Tokyo, primarily focused on home visits. I first became involved in home medical care after working on regional medical planning and the community-based integrated care system at the Ministry of Health, Labor and Welfare. As the elderly population increases and the working generation decreases, I worked to review national policies such as the reallocation of medical resources, and I felt firsthand that the era in which we have survived through acute care hospitals is about to change dramatically. I also realized that there is a strong demand for improved home medical care, which supports the elderly so that they can live at home until the end, as a new form of medical care.
　
However, there is an overwhelming shortage of players involved in home medical care, and knowledge is still limited. With the 2025 problem fast approaching, we felt that national policy guidance alone would not be enough, and decided to tackle this issue from the bottom up through practical application in the field.
　
As a pioneering initiative with an eye to the future, our hospital has independently developed the home medical care quality index "QI-8" (Figure 1), which places emphasis on maintaining a consistent level of quality in medical care. By quantitatively evaluating the quality of medical care and regularly checking the trends in the index, we are able to reflect on whether we are providing appropriate medical care to patients and establish a medical care system that allows us to intervene promptly if there are any shortcomings.
Evaluating the quality of our medical care, practicing preventive care, and preventing excessive intervention will lead to reducing patient suffering and the burden on staff. It will also contribute to the appropriate use of limited medical funds. We are convinced that building a system that is a win-win for patients, medical institutions, and the country will make the medical insurance system sustainable.

For home medical care that supports daily life
Focusing on improving the "quality of relationships" among staff

Enhancing the "quality of relationships" is also important in maintaining the quality of medical care. According to the "Cycle of Success" model proposed by Daniel Kim, co-founder of the MIT Center for Organizational Learning, when the "quality of relationships" such as how people interact with others and their communication improves, people naturally become more positive in their thinking, a sense of purpose emerges, and the "quality of thinking" improves. As a result, the "quality of actions" such as proactiveness and initiative improve, which in turn improves the "quality of results," creating a virtuous cycle in which the "quality of relationships" further improves.

In-home medical care is about supporting patients' lives while respecting not only their illness but also their lifestyles and values, and taking into consideration convenience and other factors, and because a multi-disciplinary perspective is directly linked to the quality of medical care, our hospital has adopted this approach. By incorporating the small insights, perspectives, and opinions unique to each profession into daily medical care, patients' lives become richer. It is essential to create an environment where all professions can share their opinions, in other words, to improve the "quality of relationships" on a regular basis and maintain a "high level of psychological safety" among staff members.
　
As part of this effort, our hospital has promoted the creation of an organization in which all professions have equal relationships. We hold regular weekly meetings to create a forum for dialogue among all staff members. In addition, we have a "Quality of Relationships Day" every six months, where all staff members discuss the organization's vision and values. Because conversations in daily medical practice inevitably focus on urgent matters, on this day we work to improve the quality of relationships in a workshop format, with the aim of prioritizing communication in conversations.
At the same time, in order to enrich the lives of patients, it is also important that the staff themselves feel excited about their work. For this reason, we respect the flexible and diverse working styles of our staff. For example, we encourage staff to work once a week on tasks that utilize their areas of expertise outside of their usual duties, thereby increasing their motivation to work.

To develop alternatives to home doctors
Actively recruit clinical nurses

When the number of COVID-19 infections surged, many patients were unable to be hospitalized despite needing it. As we approach 2025, a milestone year marking the aging of society, it is predicted that a similar situation will occur in elderly care, and we are reaffirming the importance of home medical care. As demand for home medical care increases, developing alternatives to doctors is an urgent issue in order to reduce medical costs, and our hospital is actively working to utilize nurse practitioners (NPs) and certified nurses.

At the same time, we believe it is also important to strengthen cooperation with acute care hospitals and promote the standardization of collaboration paths to encourage a smooth transition for elderly patients to stay at home, so that patients who truly require hospitalization can receive appropriate medical care.We are currently exploring the creation of a new elderly medical care model centered on home medical care in metropolitan areas, but based on this experience and knowledge, we are also considering taking on similar challenges in the near future in rural areas that are suffering from a shortage of various resources, including human resources.

This is a challenge that is only possible in Japan, which is becoming a super-aged society ahead of the rest of the world. A new, Japan-made model of elderly medical care, with a variety of variations to suit local conditions, will surely be useful in other countries as well. With this ambition in mind, we will carry out various demonstration experiments based on our "Home Clinic" and continue to disseminate knowledge about "medical care that supports daily life."