I want to realize transformation of the medical and welfare industry while learning from other industries ―Shunsuke Maeda, Owner/Director, Chikushi Minamigaoka Hospital
2024.02.09
Co-CreationChikushi Minamigaoka Hospital, located in Onojo City, Fukuoka Prefecture, has been independently developing and introducing AI and ICT technologies since the 2000s, with a focus on the shortage of human resources in the medical and welfare industry. We interviewed Mr. Shunsuke Maeda, the director and owner of the hospital, who established the nation’s first regional comprehensive care ward in 2014 and grew it into the largest in the region by improving productivity while ensuring safety.
―Profile
Shunsuke Maeda
After graduating from university, he first worked for a major general contractor. He then founded a custom-built housing company and served as a representative in the construction industry. In 2007, he entered the medical industry and developed the remote health management system “Anshin-net.” In 2009, he took over Chikushi Minamigaoka Hospital from his father, who was its founder, and became its director.
After moving from the construction industry to the medical industry, you have been involved in the management of medical and welfare facilities and the development and introduction of new technologies used on site for 17 years. What do you think is the biggest challenge for the medical and welfare industry?
Although there is the theme of curbing medical and nursing care costs, which increase every year due to the super-aging of the population, I believe the biggest challenge for the medical and welfare industry is the drastic decrease in the number of workers. When compared to other countries, Japan is not an attractive country for care workers to work in due to factors such as poor working conditions and a weak yen, and there is little hope for an increase in the number of foreign workers. Therefore, the Japanese government has proposed the Medical and Welfare Service Reform Plan since 2019. In this plan, it suggests measures such as promoting robots, AI, ICT, and other technologies, using senior human resources, reforming organizational management, increasing the scale of management, and facilitating collaborative management. However, the current situation is that none of the measures are working satisfactorily and have not helped to secure a sufficient workforce.
What are the factors that make it difficult for the medical and nursing care industry to make progress in the field of robots, AI, and ICT, on which the government is focusing?
I think there are two issues that prevent the advancement of AI and ICT in the medical and welfare industry. One is how to ensure safety, and the other is how to improve productivity commensurate with the burden of introducing these new technologies. For example, ICT technologies such as bed sensors are beginning to be widely used in this industry. However, although bed sensors can detect a patient’s fall, they also too often alert the device that measures vital signs. Thus, there are cases where ICT technologies do not lead to an improvement in efficiency. Particularly in medical settings, doctors often hesitate to use and introduce AI and ICT unless safety can be guaranteed.
You have been on the side that introduced such technologies as well as the side that developed systems to implement them. What is the most important issue when developing and introducing systems to be used on site?
As an example, electronic medical records for doctors to view and nursing care software designed for administrative staff have been introduced. However, these systems are not necessarily easy to use for nurses and care workers. Although the quality of medical and nursing care is improved by introducing the systems, we hear from on-site staff that efficiency has not improved. The effect of ICT on the developers’ side should not be just an additional 10-point increase, but a major transformation, such as an increase of 20 or 30 points. If this level of effectiveness is not achieved, the introduction of new systems will only increase the Burden on frontline nurses and care workers, and as a result, management will face the risk of losing human resources. The biggest purpose of DX and ICT is to reduce the burden on people working in medical and nursing care settings. In fact, however, there are many cases where this purpose has not been achieved, and this is the harsh reality.
The “Anshin-net”※1system, developed by you, automatically measures vital signs※2 and performs triage※3based on highly accurate data, thereby helping reduce the burden in medical and welfare settings. Moreover, according to the verification results of the Health and Welfare Bureau for the Elderly of the Ministry of Health, Labour and Welfare (MHLW), there is data that shows that this system could reduce work time by 50 minutes a day. How do you think a good system such as “Ansin-net” can be effectively used on site?
Obtaining the understanding of on-site staff in accordance with operations in medical and nursing care settings is as difficult as creating a system in the first place. There are not so many workers in medical and welfare settings who have a high level of IT literacy. I believe what is important is for medical and welfare workers to realize labor savings in their work through the introduction of ICT that anyone can operate and to gain experience in changing the situation in medical and welfare settings through system guidance, which leads to reducing the burden on site. The introduction of ICT is just the beginning, and unless you go to the level of DX that changes operations in medical and welfare settings and the business model itself, it will not lead to truly improved efficiency.
In particular, since vital values, such as blood pressure and pulse, vary greatly depending on the individual, it is necessary to look at changes and trends in the values of each individual, rather than applying a uniform standard, for example, that defines a fever as a temperature of 37.5°C or higher. The power of ICT and AI makes it possible to instantly and accurately make records and analyze risks to realize personalized medicine. According to the verification results of the MHLW’s Health and Welfare Bureau for the Elderly, 90% of the workers at three medical and welfare facilities that introduced the “Anshin-net” system said they felt physically better, and 78% said they felt better mentally. The accuracy of AI that intervenes in medical care is 97%. Therefore, if operations are skillfully integrated, it will not be difficult to achieve both quality in medical care, such as in preventing serious diseases, and an improvement in productivity.
※1 A comprehensive nursing care management system that is effective in early detection of diseases and prevention of severity by using AI to manage the measured vitals and detect abnormal values for each individual. It is also effective in terms of reducing the workload on staff and sharing information between different professions, leading to improved work efficiency.
※2 Referring to pulse, heart beat, breathing, blood pressure, body temperature, etc.
※3 Referring to efforts to determine the degree of urgency of patients and prioritize medical treatment according to the degree of urgency at medical institutions.
We have heard that you have been obsessed with solving problems since your days in the construction industry. What is your driving force?
When I have an uneasy feeling in my daily life, I have a habit of thinking of what can be done to make things better. For example, when a “medical classification” was applied to a recuperation ward, I felt frustrated by the fact that patients who needed a certain level of medical supervision but fell outside the medical classification could no longer stay in the hospital. At Chikushi Minamigaoka Hospital, our corporate vision was to “relieve medical refugees.” However, if the situation had remained unchanged, our hospital would have been in danger of actually producing medical refugees. Therefore, we created a medical-type nursing home where only those with care level 3 or above can be admitted. However, the reality was harsh, and we struggled with deficits for four years. Now, 10 years later, the genre of “medically intensive facilities” has been established, and in this genre, we have achieved good results. Consequently, the facility’s revenue has grown to the point where it can be said to be the pillar of our corporation. Although my vision is said to be 10 years before its time, I am moving forward with reforms without giving up, with the belief that my vision will eventually become commonplace.
With the shortage of human resources still unresolved, what challenges should medical and nursing care facilities address in the future?
Traditionally, the medical and nursing care industry has relied on human resources to improve the quality of care. Unfortunately, however, the working population in the medical and nursing care industry is decreasing. In a situation where medical and nursing care facilities rely on human resources, even if “scientific evidence-based care※4 is required to improve the quality of care, most of them will not be able to meet this requirement because they are too busy coping with the current staff shortage. In the 2024 simultaneous revision of remuneration※5,“productivity improvement” will be subject to assessment for remuneration. I believe improving productivity on site through DX using ICT is the only way to change the working conditions and work styles of doctors, nurses, and caregivers. In addition, since it is difficult for unqualified and inexperienced people to work in the medical and welfare industry, efforts are needed to guide people into this industry.
Another challenge is to reduce medical and nursing care costs. The number of people aged 85 and over will continue to increase after 2025, and the number of people requiring care will also increase. Given this, the government’s financial resources are reaching their limit. Some people argue that if medical and nursing care costs are reduced, the quality of care will decline. However, is that really the case? In other industries, there are many cases where technological advances and ingenuity have improved quality without raising prices. In the housing industry, where I previously worked, a new method of construction was introduced 20 years ago, in which unbending laminated wood is processed into structural materials in a factory in advance and these structural materials are just assembled at the construction site. This construction method made it possible to build high-quality, inexpensive houses without relying solely on the skill of craftsmen. In this way, we must always strive to make improvements and introduce innovations that are commonplace in other industries.
※4 Nursing care provided while taking into account the values and intentions of patients and users based on evidence accumulated through research.
※5 Simultaneous revision of remuneration in which remuneration for the following three services will be revised at the same time in 2024: medical services, nursing services, and welfare services for people with disabilities.
Given that human resources are important, what do you look for in a job placement agency and a temporary staffing agency like TRYT?
Although we may have to rely on the help of the government, it is essential that both the staffing placement agency side and the corporation side strive for visualization. Even if a caregiver joins a corporation through a staffing placement agency based on employment information, in some cases the caregiver quits within a month. If the refund of referral fees is 50% of the fee paid, this places a huge strain on the management of medical and welfare facilities. What’s more, caregivers who have become useful to the corporation through its training efforts end up leaving. That’s why job seekers can feel reassured before starting a job if the characteristics, type, staff assignment, and achievements in scientific evidence-based care of each medical and welfare facility are visualized, as in the hospital bed function reporting system.※6 If staffing placement agencies use such information and provide better referrals to avoid discrepancies between the staff’s perception and the actual situation in medical and welfare settings, and take responsibility for referrals, this will contribute to the development of the medical and welfare industry.
※6 A system aimed at promoting differentiation and collaboration of medical functions in the region by understanding the medical functions carried out by each ward of a medical institution through reports based on Article 30-13 of the Medical Care Act (Act No. 205 of 1948). Every year, hospitals with general and recuperation beds and clinics with beds report on the current status and future direction of their medical functions on a ward-by-ward basis.
I want to convey to the next generation that nursing care is one of the professions where we can stay closest to people.―Ms. Kiyomi Ide, Chief Caregiver
Neither the care recipient nor the caregiver should be left alone.
At a time when we can choose the type of nursing care from a wide variety of options, such as home-visit nursing care, daytime nursing care, and family nursing care, I believe our mission as care workers is to ensure that neither the care recipient nor the caregiver is left alone. With 13 years of experience in the nursing care industry, I realize that the profession responsible for nursing care, in which everyone will be involved at some stage in their life, is one of the professions where we can stay closest to people and that it is important to always think from the user’s perspective. The demands on the nursing care profession are changing with the times. Under these circumstances, in order to pass on the essence of the nursing care profession to the next generation, it is my responsibility to hone my leadership skills to improve the quality of on-site training and convey to many people the satisfaction of working as a caregiver, thereby increasing the number of people who want to become care workers.
Don’t forget to have a positive feeling that “Things will work out!”
Although I sometimes run into difficulties, I work with a strong feeling that “Things will work out!” rather than “I’ll do something about it!” when something happens. I believe if I approach the users with a positive attitude and always with a smile, such feeling will spread to the users. I feel this makes the facility a place where everyone can spend a healthy time and also gives me energy. Although the ideal form of nursing care and the nursing work that should be performed are changing little by little with the changing times and the spread of ICT, I will continue to work hard without forgetting the smiles of the users and their families and the feeling of gratitude.
Because nursing care is a core job that involves interacting with people, I stay close to the values of each patient.―Ms. Mai Ono, Chief Nurse
What is important is not only medical care skills but also communication skills and teamwork.
In the regional comprehensive care ward where I work, which provides long-term support to patients who are ready for treatment until they are discharged from the hospital, we are required not only to have medical care skills, but also to have communication and teamwork skills needed to collaborate with rehabilitation workers, social workers, nearby facilities, and patients and their families. In nurse education, instructors are conscious of guiding new nurses gently by respecting and supporting their motivation and way of thinking about work and devising ways to talk to them and ask questions. In addition, for nurses, whose job is to interact with people, one of the important elements is to acquire the ability to communicate with patients and their families in a way that expands conversation.
I want to provide options for career development amidst a serious shortage of human resources.
At a time when patients and users choose hospitals, and high quality medical care is required more than ever, I feel the shortage of nurses is becoming more serious. Among our nurses, there is a strong desire to pursue a wide variety of careers, and experienced nurses, in particular, tend to change jobs in search of career advancement. Therefore, I believe maintaining quality care despite the shortage of human resources is also an issue to be addressed. As a manager, I would like to review the education and evaluation systems in the future to create an environment where we have options for career steps other than changing jobs.
