Improving the quality of nursing care based on the principle of “user-first” —Solvillage, a geriatric health services facility operated by Social Medical Corporation Shotokukai

For our latest interview, we visited Solvillage, a geriatric health services facility located in Sakai City, Osaka Prefecture. Social Medical Corporation Shotokukai, which is Solvillage’s parent organization, began digital transformation (DX) initiatives at the 40th anniversary of its founding. The driving force behind those efforts was a strong belief in a “user-first” principle, which has been upheld throughout the group. We interviewed Akiko Hino, General Affairs Director and Masahiko Saito, Administrative Director who have promoted DX efforts, focusing on the themes of multi-disciplinary collaboration between medical and nursing care professionals, productivity improvement, and revolutionary changes in communication at worksites. They spoke to us about the path they have walked since the introduction of DX and the commitment and belief that Shotokukai has always cherished regarding the on-site efforts to support care.

Solvillage, a geriatric health services facility operated by Social Medical Corporation Shotokukai

Opened in 1996. With 75 rooms and 150 beds, the facility provides support to those in need of care through collaboration between multiple professions in the fields of medical care, nursing care, and rehabilitation to enable them to live independent daily lives. As a geriatric health services facility equipped with home return/home care support functions* that boasts a high rate of residents returning home, the facility focuses on short-term intensive rehabilitation and lifestyle rehabilitation and provides support to alleviate anxiety through pre-discharge visits and care guidance for families.

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*A geriatric health services facility equipped with home return/home care support functions is a nursing home for the elderly that meets certain conditions, such as a home return rate of 30% or above, a bed turnover rate of 5% or above, and 35% or above of users with care need levels of 4 or 5.

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―In 2019, you started discussions on promoting digital transformation. Then in 2021, you introduced seamless electronic medical records for medical and nursing care. Please tell us the background and thoughts behind your decision to make strategic investments during the COVID-19 pandemic.

Our group celebrated its 40th anniversary in 2019 and has begun making strategic investments for ICT development. With “the next 40 years” as our keyword, we wanted to realize a revolutionary change in communication in medical and nursing care settings, strengthen multi-professional collaboration through ICT, and embody the “user-first” principle that Chairman Shozo Hino has cherished since the corporation’s founding. Moreover, we also wanted to achieve both improved productivity and job satisfaction for staff members. In particular, as talent acquisition and talent development had become increasingly important, we felt a sense of crisis through actual recruitment activities about a possible staff shortage due to the declining birthrate. This made us think that DX through the use of ICT on-site would be the key to acquiring talent in the future. On the other hand, digital transformation was not yet mainstream in the medical and welfare industries at that time. Moreover, as the COVID-19 pandemic caused disruption to business operations, there was strong opposition within the corporation to the implementation of a business transformation. However, the entire group was driven by a strong belief to realize the “user-first” principle on-site. To that end, we decided to achieve seamless information sharing between medical and nursing settings, which is required to ensure collaboration between multiple professions, including medicine, nursing, caregiving, and rehabilitation. As part of such efforts, we introduced electronic medical records in 2021, which enabled the centralization of medical and nursing care information available within the group. Since then, we have provided each employee with a headset and a smartphone. In addition, we have also introduced a monitoring support system, bedside information terminals, a medical interview system using tablets, and electronic contracts.

―When it came to expanding electronic medical records, which are the gateway to multi-disciplinary collaboration, from medical care to nursing care, what hurdles did you encounter in utilizing them in the field?

Since everything was recorded on paper in the nursing care field, there was some confusion when digitization was first implemented. So, the first step was to get used to the electronic devices. Thanks to the support of the IT staff, we were able to make progress with the implementation. However, it is not easy to change things that have become habits in the workplace, and we are still working hard. Meanwhile, when it came to promoting digital transformation, a head nurse with experience in hospitals and elderly care facilities was involved from the design phase. She carefully collected, from the users’ perspective, various kinds of information, such as information needed in medical and nursing care settings, information on little problems and some issues that could only be understood in the workplaces. The nurse’s effort was useful to reflect such issues in our operations in advance. We have received a lot of feedback from nurses at the medical site, who say that they are now able to understand nursing care information in a more timely manner than before and that collaboration has improved.

―What has been the biggest change since medical and nursing care started sharing information?

First of all, work hours have been significantly reduced by systemizing the work that was previously done by people. Let’s take an example. In the past, the users’ information was created and managed separately for nursing, caregiving, rehabilitation, and administration even within the same group. Therefore, when we wanted to check a user’s information, we had to go and check the information managed in individual sections. By integrating medical and nursing information into electronic medical records and unifying users’ IDs, we have become able to centralize the entry point for information. This allows us to check the latest information of users in real time, regardless of where they receive treatment or care. As a result, the time it takes to check information has been drastically reduced to one-thirtieth of what it previously took, allowing staff to spend more time caring for users. We feel this is a major success.

This initiative also led to the provision of high-quality care and a sense of security among staff that enables consistent quality services. In the fields of medical and nursing care, hospital stays can sometimes be long. So seamless sharing of information about users is extremely important as shown by the use of electronic medical records. For example, when a patient is transported from a related facility at night, doctors can now immediately grasp the situation by looking at the electronic medical record without asking the ambulance team or on-site staff for information. Not only will this speed up response to patients, but it will also prevent communication errors and provide peace of mind. Going forward, we would like to continue to thoroughly identify areas where we can reduce labor and use the time saved to train staff and implement activities that increase user satisfaction.

―At Solvillage, not only do we find the convenience of ICT solutions, but we also find the facility to be very comfortable. What are your thoughts behind managing this facility.

As stated in our corporation’s philosophy, our mission is to “help our users bloom their own flowers of life.” We have been promoting various initiatives, such as labor savings through the promotion of digital transformation, revolutionary changes in communication, and the achievement of both improved productivity and job satisfaction. All of these efforts aim at realizing the principle of “user-first.” As you may see when you look inside the facility, we are committed to ensuring that the space in which our users spend time is bright and clean. We maintain a high hygiene level so that you can even lie down on the hallway floor. The closets are designed to evoke the lifestyles and historical backgrounds of users, with clothes stored folded rather than on hangers. We have also paid particular attention to the views from the rooms and the size of the windows and have incorporated various features to make the facility comfortable for our users. Furthermore, the cafeteria where users gather and the station* where staff gather have been redesigned to be more open, with pillars removed wherever possible. One of the features of our facility is that staff can see the status of users and other staff members at a glance. I believe that this allows active communication between staff members. In other words, ‘on-site’ is everything that counts in nursing care. Therefore, creating a staff-friendly work environment is directly linked to the peace of mind of users and the high quality of care. We will continue to evolve in the future while always cherishing the “user-first” principle.

* Space where medical staff perform medical administration tasks, research, education, etc.

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Interview with care workers Hashimoto and Shibukawa about DX operations in the field and their thoughts on users

All staff working together to provide our users with care that conveys the warmth of people

Mai Hashimoto,  Chief of the Nursing Care Section, and Care Worker

When I was in my third year as a care worker, I was looking for a new job with a focus on end-of-life care, wishing to grow and increase my knowledge. That was when I came across this facility. The appeal of this facility includes the following: that there is active communication between staff members; that every member’s opinions are respected regardless of previous experience, knowledge, age, or area of responsibilities; and that there are many opportunities for individuals to make the most of their abilities. It is recommended here that care workers should also know about medical fields. So, medical staff help care workers acquire medical nursing knowledge. Naturally, many staff members often engage in active conversation as to what we can do to provide thorough care or what type of care we would like to offer. We have a comfortable relationship where we can improve each other, sharing the same perspective of “customer-first.” So two years have passed in the blink of an eye.

On the “end-of-life” floor that I am in charge of, we must closely observe the patients’ vital signs, such as blood pressure, temperature, and oxygen levels, so as not to miss even the slightest changes. In approaching the end of life, a patient often exhibits conditions such as a slower heart rate and longer sleep times. Care workers are not allowed to use a stethoscope. However, we can immediately make a correct judgment even when we are not in front of the patient if the data is visualized through a smart mat system. Being able to keep an eye on the patient’s condition, which is visualized on a monitor or smartphone, allows us to concentrate on our work without worrying that we might find that the patient has already passed away the next time we visit the patient. Whenever we find some changes in the data, we immediately visit patients, hold their hands, talk to them, and rub their hands if they are in pain. We cherish such type of care, which gives comfort to patients through human warmth.

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On-site operation being the key to improving quality of care

Takuma Shibukawa,  Chief of the Nursing Care Section, and Care Worker

This year marks my 12th year working in the nursing industry. My previous jobs, including the one at a paid nursing home, involved keeping records mainly on paper. So I used ICT equipment in care work for the first time at this facility. At first, I was not very good at using them and ended up using conventional methods I was familiar with, such as using a laptop or writing notes by hand. However, when close collaboration between staff members was required in a short period of time, I realized the convenience and importance of ICT equipment. For example, in the past, when visiting the room of a patient with an infectious disease, we had to put on and take off a gown every time we entered and left the room. However, vital signs, including body temperature, can now be measured in the patient’s room, and such medical data can be sent via mobile equipment. This eliminates the risk of contact with other staff members or users and the hassle of putting on and taking off a gown. I feel that tablets that can record data at the user’s bedside and headsets that allow instant contact with staff at a different location have also led to improved quality of care and more efficient operations. Meanwhile, some staff members are uncomfortable using electronic devices or are reluctant to learn new things, while others enjoy taking the time to do care tasks without automating them. In order to ensure that each and every staff member can feel the benefits of ICT equipment in their care work, I would like to first communicate the convenience of ICT to the staff working in the field and help them operate it. I believe this is the key to providing care from the perspective of our users.