We still tend to feel somewhat uncomfortable when combining medical and nursing care with the term "management.” This is likely due to the fact that these businesses exist to protect people's lives. However, in the increasingly severe environment faced by enterprises engaged in medical and long-term care, advanced management skills are fast becoming indispensable for the survival of these enterprises in the life-saving business.
The Ritsumeikan University Research Center for Medical and Long-Term Care Management (MLTCM) is a research center that conducts research on management issues in medical and long-term care and trains management personnel. We interviewed Center Director Hiroshi Koezuka (Professor, Ritsumeikan University Business School), about the current state of the medical and long-term care business and the research activities the Center is undertaking to meet the needs of those on the frontlines.
Increasing importance of management in the medical and long-term care business amid changes in the business climate
Professor Koezuka began the interview by describing the unique situation of Japanese medical institutions and the changes that led to the establishment of the Center.
Approximately 80% of medical institutions in Japan are privately owned and operated, a situation that differs greatly from Europe and the United States, where most medical facilities are publicly owned and operated. Even though most Japanese medical institutions are in the private sector, the government has strong authority over the structure and content of the healthcare delivery system, which the government is responsible for financing via the universal health insurance system and other sources.
“For a long time, most medical institutions in Japan were scarcely aware of the importance of management, and there was a sense that it was good enough to run the business without adopting various management techniques. In fact, these institutions did not run into much trouble. This is because the public demand for medical care continued to grow as the population increased from the Meiji era onwards and improvements were made to the healthcare delivery system, and since the 1970s, more and more people have been seeing doctors due to the aging of the population.”
However, things began to change in the 1990s and 2000s. The declining birthrate and aging of the population have led to a more pronounced trend of population decline, and Japan started to experience a lack of human resources in the medical care field.
“What’s more, the demand for medical care itself has been decreasing due to the decline in the population, including the elderly. There is a growing realization that this is a very serious situation for medical institutions, and the importance of healthcare management has started to garner close attention."
Amid this backdrop, Ritsumeikan University established the Medical Management Research Center, the predecessor of MLTCM, in 2009.
“At the time, our goal was to conduct research on hospital management and identify management issues. At the same time, in order to share the outcomes of this research, the Center also offered courses for people involved in hospital management, like hospital directors, office managers, and board chairpersons. We also focused on training healthcare managers.”
Carrying on the achievements of its predecessor, the Research Center for Medical and Long-Term Care Management (MLTCM) was established in 2019. Recognizing that the challenges facing the medical field concurrent with a declining population are common to the nursing care field as well, the Center expanded its scope of research and made a fresh start.
Prospects for hospital management in response to the government’s Regional Healthcare Plan
MLTCM conducts problem-oriented research in medical and nursing care settings in collaboration with researchers in various academic fields, including business administration, life science, pharmaceutical science, and sports and health science. According to Professor Koezuka, MLTCM is unique in that it conducts research from the standpoint of "management,” as the name of the Center implies.
“There is a lot of research looking at healthcare through an economic lens, but there is still a lot of research that needs to be done to shed light on healthcare from a management perspective. In particular, there aren't many researchers specialized in business administration who study long-term care management yet. There are only a few centers that specialize in research on healthcare management itself, and when it comes to long-term care management, there is only a small handful of researchers. We would like to conduct fundamental research to clarify what it means to manage not only medical enterprises but also long-term care enterprises as well as the kinds of skills required for personnel involved in the management of these enterprises.”
Linking this kind of research to practical applications in society is another an important activity of the Center. This is especially true now that both the medical and long-term care sectors are reaching a turning point, and management skills are needed to respond to the changing times.
A big topic in healthcare management is realizing the Regional Healthcare Plan that the national government enacted in in 2014. The goal of the Regional Healthcare Plan is to project Japan’s medical needs in 2025 and establish a system of role-sharing and collaboration among medical institutions in cooperation with local stakeholders. The aging of the population differs in each region, as do the types of prevalent diseases. Based on the plan, each prefecture will periodically formulate medical plans and promote specific measures to ensure they have a healthcare delivery system in place that takes into account regional characteristics.
“Each hospital needs to clarify what role it will play in the medical service area, while keeping an eye on trends in medical planning. To achieve this, they must address important management issues such as what departments to have, what type of medical care to provide, and securing suitable physicians based on this, not to mention establishing a nursing framework and optimizing the number of patient visits and bed occupancy rates."
Realizing the best possible form that a hospital should take while taking into account complex factors and predicting the future is a highly sophisticated management decision. MLTCM, in collaboration with hospital managers and practitioners, has launched a project to identify issues pertaining to how hospital management should respond to the Regional Healthcare Plan. The Center aims to see the results of this project utilized in the management of many hospitals.
Digitalization of long-term care in collaboration with startup companies
On the other hand, according to Professor Koezuka, one epoch-making event in the management of long-term care will occur when facilities undergo renovations. In preparation for the introduction of long-term care insurance in the year 2000, a large number of new long-term care facilities were built across the country beginning in the late 1990s. Now, more than 30 years later, efforts are underway throughout Japan to start renovating these aging buildings.
“This is not only an opportunity to renovate outdated facilities, it is also an opportunity to improve service and value by making rooms and common spaces more livable and comfortable, by creating more worker-friendly environments, and so on.”
As the demographics of local communities change in step with the declining population and it becomes more difficult to secure residents and long-term care personnel, the reconsideration of facilities and equipment will become an important management issue.
Attention is also being paid to digitalization, an area where the long-term care sector is lagging. MLTCM is working on a project to promote the use of digital technology, which also involves improving the services and value of long-term care facilities. MLTCM is working to develop equipment and systems that can automatically obtain patients’ vital data using sensors and easily input the information necessary for long-term care insurance claim paperwork onsite, with the aim of enhancing support for effective long-term care operations.
“We are working with the Osaka Association of Geriatric Health Services Facilities to identify the on-the-ground needs in long-term care and develop digital devices and systems together with long-term care startup companies. There is great potential for digitalization to spur innovation in long-term care services. Going forward, we plan to strengthen partnerships with outside institutions and expand upon this project.”
Spurring innovation by connecting research to practice
Professor Koezuka explains the meaning of the Center's active collaboration with external organizations for practical applications in society as follows.
“By creating links with medical and long-term care facilities, companies, and local governments, we hope we can combine everyone's knowledge to create something new. This is also where cutting-edge issues arise that the Center should explore further. We hope to serve as a nexus that links research to practice.”
Going forward, the Center also plans to implement training programs for hospital managers. The hope is that a wealth of practical knowledge can be shared and reflected back into the Center’s research. Professor Koezuka also talked about how he would like to expand the Center’s networks with startup companies to explore the possibilities for innovation.
What’s more, Ritsumeikan University concluded an agreement with Osaka Dental College in August 2023. The aim of this agreement is to enhance oral and nutritional management by leveraging Osaka Dental College's knowledge of oral hygiene and oral/swallowing function improvement as well as the network the Center has established with long-term care facilities and long-term care-related startup companies.
“The management of nutrition through the maintenance of oral and swallowing functions, as well as the prevention of frailty, are extremely important issues for supporting the independence of the elderly and preventing the aggravation of disabilities. Through our collaboration with Osaka Dental University, naturally, we will gain new knowledge about oral and nutritional management and frailty prevention in long-term care settings, but we would also like to focus on research that will lead to the creation of even more new services and systems.”
MLTCM focuses on the future of the medical and long-term care business in the world's grayest society. There are high expectations for innovation to be created by understanding the situation on the ground and collaborating extensively with industry, government, and academia.
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