Healthcare Management and Care Processes

Central clinical service departments — the pharmacy, clinical laboratory, radiology, operating, and rehabilitation departments, among others — belong to no single specialty and support care jointly for all clinical departments. The medical affairs office handles insurance claims, reception, and payment and belongs to the administrative side, so it is not a central clinical service department.

The health information management department checks and stores clinical records, codes disease names, audits clinical documentation, compiles statistics, and manages DPC data and cancer registry data, with health information managers at its core. Dispensing belongs to the pharmacy department, menus to the nutrition department, and equipment maintenance to clinical engineering.

The medical fee processing (medical affairs) department prepares insurance claims and bills medical fees, handles reception and payment, responds to claim assessments, and prepares detailed symptom statements. Nursing care planning belongs to the nursing department, surgical assistance to the nursing and operating departments, and system development and operation to the medical informatics department.

The medical informatics department operates and maintains the hospital information system, manages networks and data, and implements information security measures. Explaining diagnoses and deciding treatment plans are physicians' work, and claim assessment is done by the examination and payment organizations.

The bed occupancy rate, a representative management indicator, is average daily inpatient census ÷ number of beds × 100 (%). 170 ÷ 200 × 100 = 85%. The same value is obtained by dividing total inpatient days by beds times days. 75%, 90%, and 117% do not fit the calculation.

Average length of stay is calculated as total inpatient-days ÷ {(new admissions + discharges) ÷ 2}. 3000 ÷ {(180 + 220) ÷ 2} = 3000 ÷ 200 = 15 days. In acute care hospitals, shortening the average length of stay is an important indicator for management and functional evaluation. The other options do not fit the calculation.

The outpatient/inpatient ratio divides the average daily outpatient count by the average daily inpatient census: 600 ÷ 300 = 2.0. It is one of the management indicators showing the balance between a hospital's outpatient and inpatient activity; the other options do not fit the calculation.

Quality of care is evaluated along 3 aspects: structure (facilities and staffing), process (the course of care), and outcome (the results). The 5-year postoperative survival rate shows the result of treatment and is an outcome indicator. Staff numbers and device counts are structure indicators, and guideline adherence is a process indicator.

PDCA is a management method that continuously improves the quality of work by repeating the cycle of Plan, Do, Check, and Act. P means planning and C means checking (evaluation), and it does not end after 1 round. It is widely used in hospital management and in quality and safety management of care.

A BCP (business continuity plan) sets out the policies, structures, and procedures for continuing critical operations during natural disasters, pandemics, or serious system failures, and for restoring interrupted operations early. It does not prescribe halting all operations, nor is it a construction or cost-cutting plan. Hospitals are expected to build structures for continuing to provide care even in disasters.

An incident is a case in which an erroneous act was discovered before being carried out on the patient, or was carried out but did not result in injury; it is also called a near miss (hiyari-hatto). Cases in which the patient was injured are accidents (medical accidents). Incidents are not limited to deliberate wrongdoing, and they are subject to reporting and analysis for prevention of recurrence.

Heinrich's law is the empirical rule that behind 1 serious accident lie 29 minor accidents, and behind those lie 300 near misses. The statement reversing the 29 and 300 is wrong. It is not a view that blames accidents solely on individual carelessness; it shows that analyzing causes and acting at the near-miss stage helps prevent serious accidents.

The purpose of incident reports is to collect and analyze cases, clarify causes, and improve prevention of recurrence and patient safety — not to serve as material for blaming or disciplining reporters. Using them for blame suppresses reporting, so non-punitive operation is the rule. Reports come from all professions, and the analysis feeds the drafting of improvements.

The patient safety department collects and analyzes incident and accident reports, runs staff training on patient safety, drafts and disseminates measures against recurrence, and maintains the patient safety management structure. Billing medical fees is the work of the medical affairs department, not the patient safety department.

The medical accident investigation system covers deaths and stillbirths caused, or suspected to be caused, by the care provided, which the administrator did not anticipate. Not all falls, complaints, or injury-free administration errors are covered. For covered cases, an in-house investigation is conducted, the results are explained to the bereaved family, and a report is made to the Japan Medical Safety Research Organization.

Under the medical accident investigation system, when a covered medical accident occurs, the institution's administrator reports it without delay to the Japan Medical Safety Research Organization and conducts an in-house investigation. The system does not prescribe reporting to the police, public health centers, or courts. Its purpose is not to assign blame but to secure patient safety by preventing recurrence.

Standard precautions are the foundation of infection control: they apply to all patients regardless of infection status, treating blood, body fluids, secretions, excretions (excluding sweat), mucous membranes, and non-intact skin as potentially infectious. They are not limited to infected patients, hand hygiene is still required after removing gloves, and sweat is excluded.

Transmission-based precautions add measures matched to the transmission route — contact, droplet, or airborne — on top of standard precautions. They are not performed alone in place of standard precautions, and because the necessary measures differ with the type of infection (its transmission route), a single uniform measure for everything is also wrong.

The ICT (Infection Control Team) is composed of multiple professions — physicians, nurses, pharmacists, laboratory technologists, and others — and carries out infection control activities such as hospital rounds, surveillance, support for appropriate antibiotic use, and staff education. Improving nutrition is the NST's role, and it is not made up of physicians alone.

In triage, patients are classified by urgency and severity: red (I) for the highest-priority group needing immediate treatment, yellow (II) for the delayed treatment group who can wait somewhat, green (III) for the minor (hold) group, and black (0) for those beyond saving or deceased. The color for the highest-priority group is red.

The chief complaint is the symptom the patient most strongly presents as the reason for the visit. The medical interview also covers the history of the present illness, past medical history (diseases previously suffered), and family history, forming the starting point of the diagnostic process. Test values are information obtained from examinations and tests, not the chief complaint.

Physical findings are obtained through physical examination — inspection, palpation, percussion, and auscultation. The medical interview is the act of listening to the patient and family to obtain the chief complaint, history, and other information, and is not a physical examination technique.

A first visit means the patient consults that healthcare institution for the first time for that illness or injury; the second and subsequent visits are return visits. Outpatient care flows through reception, interview and examination, tests, diagnosis, prescription, and payment, and the first/return distinction also affects fee calculation (first-visit and return-visit fees).

The admission care plan document records the disease name, symptoms, treatment plan, planned tests, and estimated length of stay, and under the Medical Care Act it must be handed to the patient and explained within 7 days of admission. It is drawn up jointly by physicians, nurses, and other professions; it is not prepared after discharge, and giving it to the patient is not prohibited.

The discharge summary is a record summarizing the course of the hospitalization, the treatments and tests performed, the patient's condition at discharge, and the post-discharge treatment plan, helping ensure continuity of care in outpatient clinics and referral institutions. It is not an admission test schedule, a bill, or a diary written by the patient.

Clinical care can be viewed as flows of people, goods, and information. Reporting test results is a flow of information. A patient moving is a flow of people, and transporting drugs or specimens is a flow of goods. The hospital information system mainly supports the information flow, and links to the flows of people and goods through orders and result reporting.

A clinical path is a standard care plan that lays out tests, treatment, nursing care, meals, activity levels, and so on along a timeline; it serves standardization of care, promotion of team medicine, appropriate lengths of stay, and explanations to patients. It is not based on an individual physician's experience alone — it is created and used by multiple professions.

Variance refers to a state deviating from the course or achievement targets (outcomes) planned in the clinical path. Outcomes are the targets themselves and are distinguished from variance. Collecting and analyzing variances leads to improving the path and the quality of care. It is not a fee bonus or the patient's brought-in medications.

The nutrition support team is abbreviated NST (Nutrition Support Team); physicians, nurses, registered dietitians, pharmacists, and others jointly support patients' nutrition management. ICT is the infection control team, RST the respiratory support team, and RRT the rapid response team — all representative examples of multidisciplinary team medicine.

Team medicine means physicians, nurses, pharmacists, rehabilitation professionals, and other professions each apply their expertise while sharing information and cooperating through conferences and the like in treatment and care. It is not one-way instruction or independent activity by each profession, and a wide range of professions take part, including medical social workers and administrative staff.