Is patient safety sufficient in Japan? Differences in patient safety between Japan and the United States – Learning from the United States

Abstract

In Japan, patient safety has been promoted at all levels since the 1999 landmark adverse medical event at Yokohama City University Hospital (YCUH). However, patients do not believe that health care is becoming safer. Furthermore, two university hospitals (UHs) that were designated as "advanced treatment hospitals" had their status revoked by the Health Ministry as of June 1, 2015 due to patient safety problems. The history of patient safety in Japan can be roughly divided into two terms: 1999-2009 and since 2010. In the first term, a basic patient safety system was established that included the creation of a patient safety division and an incident-reporting system from the perspective of systems error rather than individual responsibility. Additionally, many companies have promoted the improvement and development of drugs and medical devices in collaboration with health care providers. The two recent serious medical errors at UHs seemed to occur partially due to a lack of medical ethics. Unlike in the United States (US), in Japan, there is no medical license renewal system, the organizations that govern physicians are weak, and the framework of lifelong education is inadequate. Therefore, the second term involves a mindset of quality-driven patient safety. It requires health care providers and policy makers to change their mindset toward medical ethics and patient safety by learning from the US and demands a strong organization and framework to govern physicians in Japan.

Regulating risks in healthcare in Japan: Between new politics and the tradition of liberal practice in medicine

“…Similarly, the regulation of risks to patients has come under severe scrutiny since the late 1990s because of several scandals and an increase in the number of litigations. As a result, there have been several reform attempts over the last twenty years (Hirose, 2016). The collection of incident data by a third-party organization (Hirose et al, 2003), and a no-fault compensation scheme for cerebral palsy (Hasegawa et al, 2016) are two examples of such reforms.…”

“…In 2002, the National University Hospitals' Patient Safety Assembly was set up under the Permanent Committee of the Board (National University Hospitals' Patient Safety Assembly website). The assembly consists of 42 national university hospitals nationwide, and meets twice every year to discuss patient safety issues (Hirose, 2016). provide an official complaints resolution system, Medical Safety Support Centers (MSSCs) were also established in every prefecture and major city.…”

“…In October 2002, the MHLW amended the Ministerial Ordinance, obliging accredited health providers (including all national hospitals) to ensure safety measures by reporting medical errors (enacted in October 2004). Concerning the task of gathering and analyzing this data, the previously-mentioned third-party body, JCQHC was chosen by the government as an appropriate body to perform this function (Hirose, 2016). Two of the major functions provided by the JCQHC are: hospital accreditation (which is not mandatory, and is independent of the government) and adverse/near-miss event data collection and analysis (approved by the government).…”

“…The Medical School of the University of Tokyo was designated as the center for providing training for MSSCs' staff. While this Act (Fifth Amendment) took effect the following year, a new fee schedule was introduced in April 2006, offering each provider financial incentives (the preferential patient safety countermeasure fee (PPSCF)) to implement patient safety measures (Hirose, 2016).…”

Do pharmacists have the most potential for patient safety in Japan? Learning from a 2010 nationwide survey

“…[3] Curiously, in Japan, health professionals acknowledged that the incorrect surgeries performed at Yokohama City University Hospital (YCUH) on January 11, 1999, increased the attention given to PS activity at hospitals. [4,5] Subsequently, on February 11, 1999, a 58-year-old female with rheumatoid arthritis died after surgery because she received disinfectant intravenously at Tokyo Metropolitan Hiroo Hospital. In this case, the nurse in charge mistakenly substituted a syringe full of Chlorhexidine gluconate for another syringe with anti-coagulant.…”