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Initiatives for Medical Care Field

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Supporting a Medical Institution Restructuring Project to Create the Community Medical Care Systems of the Future

Addressing the Tasks of Differentiating Medical Institution Functions and Promoting Regional Collaboration to Progress toward "Optimal Medical and Nursing Care"

The rise in social security expenses associated with demographic graying has become one of the principal factors causing the deterioration of Japan's fiscal soundness. Aiming to sustain the country's social security systems despite the emerging "super–aged society," the government in June 2011 released its "Definite Plan for the Comprehensive Reform of Social Security and Tax"—a blueprint for creating optimal medical and nursing care systems by 2025 (the so–called "2025 model"), when members of Japan's "baby boom" generation will be 75 or more years old.

By promoting progress with respect to "the differentiation and strengthening of hospital inpatient medical care functions," "collaboration among medical care institutions and between medical care and nursing systems," and "the improvement and strengthening of home medical care," the 2025 model aims to optimize the utilization of limited medical care resources (human, financial, and equipment resources, etc.) and indicate the direction of measures for building systems capable of more–effectively and more–efficiently providing medical care and nursing care services.

The fiscal 2012 revision of medical fee reimbursement levels provides generous funding for medical care institutions that emphasize coordination with other medical care institutions and nursing care facilities, medical care institutions that emphasize home medical care programs, and medical care institutions that emphasize other management measures in line with the 2025 model. To achieve progress toward the 2025 model, Japan's medical care institutions must naturally clarify the functions that they should be responsible for while also making additional function strengthening and function converting efforts as well as additional efforts to strengthen their collaboration with other medical care institutions and nursing care providers.

Reorganization of Medical/Nursing–care Functions (2025 Model) Targeted by the "Definite Plan for the Comprehensive Reform of Social Security and Tax"
Image: Reorganization of Medical/Nursing–care Functions (2025 Model) Targeted by the "Definite Plan for the Comprehensive Reform of Social Security and Tax"

Source: Prepared by the Industry Research Division of MHBK based on Ministry of Health, Labour and Welfare materials

Drawing on Mizuho's Overall Strengths to Help Medical Care Institutions Overcome Management Challenges

Anticipating that the healthcare industry centered on medical/nursing care services will be an important growth industry that supports Japanese society going forward, Mizuho is drawing on the Mizuho Group's overall strengths to help medical institutions throughout Japan overcome management challenges and thereby realize the 2025 model.

MHBK has assigned hospital specialists to its Industry Research Division's Healthcare/Specified Corporation Team (currently, the Corporate Marketing Division's Specified Corporation Team). Working in collaboration with branches, these hospital specialists undertake discussions with medical care institution managers and strive to help them overcome the various challenges they are facing.

Specifically, the hospital specialists provide up–to–date information about government– and industry–related trends, consider problem–solving measures, respond to funding needs, and offer other kinds of assistance. In addition, MHBK is collaborating with MHRI and MHIR to provide consulting services related to the various kinds of challenges that medical care institutions are facing.

Support for the Integration and Restructuring of Tochigi City's Community Medical Care Centers

One example of the kinds of initiatives Mizuho has been making to overcome the management challenges faced by medical care institutions is the support it has provided for the Community Medical Care Restructuring Project (hereinafter, the Project) being implemented in the southern area of Tochigi Prefecture, which has found it difficult to sustain community medical care systems owing to shortages of physicians and other factors.

The Project aims to effectively use limited medical care resources and realize high–quality medical care by integrating and restructuring three leading hospitals in Tochigi City—Tochigi Prefecture Welfare Federation of Agricultural Cooperatives Shimotsuga General Hospital (467 beds), Yokikai Tochinoki Hospital (165 beds and a long–term geriatric nursing care facility annex with 50 beds), and the Shimotsuga–gun Municipal Medical Association Hospital (112 beds)—and thereby establish a large–scale and comprehensive medical center able to effectively serve the local community by meeting a wide range of medical and nursing care needs. Specifically, by renovating and reconstructing existing hospital wards, obtaining additional land, and taking other initiatives, the Project aims to create two community hospitals with clearly differentiated roles (a medical care center focused on acute, sub–acute, and secondary emergency patients and a medical care center focused on recovery and chronic care patients) along with a general healthcare support center responsible for operating geriatric nursing facilities as well as providing support for medical examinations and home care services. This large–scale project is designed to generate a high level of social benefits, and it has been allotted a special grant from the national government for community medical care rehabilitation projects as well as other grants and subsidies from the national government, Tochigi Prefecture, and Tochigi City that, together, are expected to total JPY 8.8 billion.

Since the 2011 announcement of the merger of the three hospitals, MHBK's Tochigi Branch, hospital specialists in MHBK's Industry Research Division (currently, the Corporate Marketing Division), and MHRI medical institution management consultants worked together to gain an understanding of the needs of Tochigi City as well as long–term customer Yokikai Tochinoki Hospital and provide sustained support to meet those needs. Specifically, Tochigi City's Community Medicine Countermeasures Office was supplied with marketing information on the surrounding medical care environment and other subjects, and concurrent management support measure proposals were made along with introductions to potential partner companies with capabilities for helping improve hospital management systems. MHRI presented a medical care management support plan proposal. In these and other ways, the Mizuho Group dynamically provided support for measures aimed at realizing improved community medical care systems.

As a result, the Tochigi District Medical Center (tentative name) Establishment Preparation Committee (hereinafter, the Committee) decided in June 2012 to commission MHRI to perform consulting work related to the Project, and the institute has subsequently provided various kinds of support, including the drafting of a basic plan for new hospital ward construction; the creation of organizational, personnel, and other systems for the medical center; the creation of all types of implementation systems for the new corporation operating the medical center; the implementation of procedures for establishing the new corporation; and the drafting of management strategies. The Project has progressed while creating a solid foundation for ensuring transparency and creating optimal community medical care systems in line with the customer's wishes.

At the time of the selection of contractors to design new hospital wards, for example, after consultation with the Committee, the "public proposal" method was employed to ensure transparency. This open–type method entailed identifying a limited number of design companies that have demonstrated their construction work performance capabilities, inviting those companies to directly make presentations to the managers of the Project, the immediate evaluation of the presentations, and the same–day announcement of the evaluation results.

In addition, the integration and reorganization process was designed to help overcome challenges associated with medical care personnel shortages. The hospital with acute stage care capabilities, the geriatric nursing facility, the general healthcare support center focused on examinations, and other facilities each had to be assigned specific functions so that—despite the diverse duties, work schedules, and other employment conditions of medical staff members—work environments could be created that enable each member of the medical staff to make the most of his or her respective capabilities.

In view of this need, MHRI proposed a post–integration/reorganization organizational and personnel system in which all medical staff members would be directly employed by a newly established entity, the "Tochigi Medical Center General Incorporated Foundation." As a result of the acceptance of this proposal, an organizational and personnel system has been created that allows for flexibility in the assignment of personnel to multiple facilities based on consideration of each employee's capabilities, experience, age, physical condition, and family situation. In addition, a management by objectives and an evaluation system have been positioned at the center to enhance the motivation of its medical staff members and other employees by systematically ensuring that employee performance will be appropriately evaluated.

In these ways, diverse workplaces have been created along with an environment designed to enable medical staff members to sustain their work for protracted periods, and this is expected to lead to a further improvement in the quality of community medical care services. In addition, a "regional health care information system" has been created to enable the sharing of medical records with other hospitals and clinics in the region, and plans call for the progressive implementation of additional measures designed to promote the strengthening of medical and nursing care–related collaboration among facilities throughout the southern area of Tochigi Prefecture.

With respect to corporate functions, the concentration of planning, personnel, accounting/finance, and procurement functions within the medical center's headquarters will enable the corporation to undertake unified initiatives and create an environment that will facilitate efforts to increase efficiency and upgrade the quality of operations.

Besides supporting the creation of these management systems, Mizuho plans to collaborate with regional financial institutions in providing the newly established corporation with working capital. Regarding funding needs associated with the construction and operational inauguration of new hospital wards going forward, Mizuho is considering the organization of syndicated loans in cooperation with regional financial institutions, and it plans to sustain its various kinds of support for the corporation over the long term.

Image: Artist's Rendition of New Hospital Building (prepared by Yamashita Co., Ltd., at the pre–basic–design stage)

Artist's Rendition of New Hospital Building (prepared by Yamashita Co., Ltd., at the pre–basic–design stage)

Employee Voices

Photo: Yuichi Watanabe Senior Consultant, Management Strategy Team, Consulting Department, Mizuho Research Institute

Yuichi Watanabe
Senior Consultant, Management Strategy Team,
Consulting Department, Mizuho Research Institute

This kind of project, which involved the integration of public– and private–sector hospitals to create a large–scale medical care center that will be the core medical care unit in its region, is still extremely rare in Japan at this point. It will be attracting considerable attention going forward as a model case that can help indicate the ideal direction of the future evolution of the country's community medical care systems.

Besides high–quality medical service provision capabilities, medical care institutions must have solid management systems to support those capabilities. As it prepares for additional initiatives designed to strengthen Japan's community medical care systems going forward, MHRI is planning to work in close cooperation with MHBK and other partners in efforts to enable medical care institutions to overcome the various management challenges they face.

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