About the Department of Clinical Quality Management

Osaka University Hospital is one of the largest national university hospitals in Japan with 1076 beds and approximately 2000 employees including 800 physicians. One of the hospital’s missions is to provide advanced medical care while maintaining quality of care and patient safety.
The Department of Clinical Quality Management, established in 2001, has the following features:

・is the first department focused on maintaining quality and safety among Japanese hospitals
・has a multidisciplinary team with 9 full-time clinicians including physicians, nurses, and health information managers
・acts as the Secretariat for the Patient Safety Association of 45 Japanese national university hospitals
・has been providing annual seminars for patient safety for all Japanese university hospitals for the past 8 years

A Brief History of Patient Safety in Japan

The issue of patient safety in Japan was brought to the forefront because of a highly publicized instance of “switched surgeries of two patients” at a university hospital in January 1999. The particularly relevant book “To Err is Human” was published in the same year. In response to the error, the Ministry of Health and Welfare has mandated that university hospitals and some other healthcare institutions follow seven regulations for patient safety. These regulations require the following: a policy for patient safety; hospital-wide incident reporting; a functional committee for patient safety; staff education on patient safety; a full-time patient safety manager; a patient safety office; and a patient complaint office.

Patient Safety Activities and Preventive Measures in Osaka University Hospital

Web-based Incident Reporting System

A web-based incident reporting system has been designed, taking into consideration convenience as well as psychological factors important to those responsible for reporting and monitoring activities. Major types of incidents commonly reported have been medication errors, line and tube complications, and falls.

Organizational Structure for Patient Safety

Clinical Risk Management Committee

In 2000, an organizational structure with three key components was introduced to address patient safety. The clinical risk management committee is responsible for planning and making key decisions. Our department implements plans by interacting with other department clinicians. Departmental clinical risk managers perform the specific tasks at their units.

Quality Review Committee

A hospital-wide peer review system to address serious adverse events, including unexpected events, has been active since April 2005. The purpose of the Quality Review Committee is to improve care and achieve accountability.

Actions for Patient Safety

Alerts

Mailing lists
Patient Safety News
Quality Management News

System-oriented improvements

Elimination of look-alike drugs
Elimination of sound-alike drugs
Development of fool-proof equipment
Prevention of foreign bodies retention in surgery
Prevention of errors in the electronic order entry of medications
Prevention of falls
Prevention of blood type (ABO) incompatibility in blood transfusions

Ward rounds

Patient identification
Medication / transfusion process
Ventilator check sheets
Emergency items in crash carts
Interviews with patients

Education

Seminar
E-learning
Since December 2006, We have introduced e-learning covering patient safety education for busy clinicians who have difficulty in attending seminars. Quiz questions, animated lessons about SBAR communication skills, and other educational materials have been provided.

Other hospital-wide activities

・Medical Emergency Team (ICU & ED physicians)
・Regimen management and mixing of chemotherapy agents by pharmacists (Pharmacy Dpt)

Development of Education and Training Programs for Patient Safety (2009 - present)

This project aims to develop educational and training materials and methods for patient safety in clinical settings, with support from the Special Education and Research Fund of the Ministry of Education, Culture, Sports, Science and Technology in Japan. We are focusing on improving the performance of medical teams, with an emphasis on improving non-technical skills of clinicians. We are also planning to train patient safety specialists by using packaged educational programs that we have developed. In addition, we plan to evaluate the effectiveness of these educational programs.

Our activities in 2009 included:

・An annual seminar for patient safety for all Japanese university hospitals, involving 238 participants (24 to 26 June 2009);
・Translation of Mr. Martin Bromiley’s article, “Have you ever made a mistake?” (Bulletin of Royal College of Anaesthetists 2008;48:2442-2445), and DVD, “Just a Routine Operation” (http://www.chfg.org/), into Japanese.
・Development of our original case studies as educational materials to learn about non-technical skills, early recognition and response, and effective utilization of incident reports, by using a hypothetical healthcare institution, “Naniwa Smiley Hospital,” where the main characters of Dr. Running Circles, Dr. Sherlie Shy, and Nurse Truly Honest are being trained.
・Development of a new e-learning system suitable for healthcare institutions, especially university hospitals.
・Educational seminars targeted at junior residents, physicians, and nurses, covering various topics including pediatric BLS, communication in emergencies, hands-on instruction on ultrasound-guided CVC placement, and nutritional support.

Medical Education at Osaka University

	Patient safety (90 min)
		Targeted students: 3rd year students of medicine, dentistry, pharmacy, and allied health sciences. Aim: to understand human errors in daily life and healthcare settings and basic principles of prevention.
	Clinical risk management (60 min*3=180 min)
		Targeted students: 5th year medical students. Aim: to understand the epidemiology of adverse events, a system approach to prevention of errors in clinical settings, the importance of communication among clinicians for patient safety, and professional liability and insurance in healthcare.
	Patient safety, quality management, and infection control in healthcare (90 min*8=720 min)
		Targeted students: graduate students in the master of science track in the Program of Cultivation of Health Care Professionals in Public Health. Aim: to understand issues of quality and safety in healthcare from the viewpoint of clinical medicine, health policy, and legal system.

International Conference Presentations

Invited lectures

	Nakajima K. Implementation of a patient engagement program: process, tools and culture. International Forum on Quality and Safety in Healthcare 2013 (London, 19 April 2013).
	Nakajima K. Development and implementation of a hospital-wide patient engagement program,“Iroha-uta,”to improve patient safety.International Symposium of Healthcare Quality and Safety (Douliou, 30 March 2013).
	Nakajima K, Takahashi R. Twelve-year experiences of patient safety and quality improvement and the latest challenges to non-technical skills and patient engagement in Osaka University Hospital. International Meeting on Patient Safety, Taiwan Joint Commission on Hospital Accreditation and Osaka University Hospital (Taipei, 28 March 2013).
	Shimizu K. Synbiotic therapy in severe SIRS. Symposium: Health & Diseases. The 5th Asian Conference on Lactic Acid Bacteria: Microbes in Disease Prevention & Treatment (Singapore, 2 July 2009).
	Shimizu K. Intensive care and the application of probiotics. The 5th International Yakult Symposium “The gut and more” (Amsterdam, 18 June 2009).
	Nakajima K, et al. A web-based incident reporting system with multidisciplinary collaboration for patient safety. Knowledge Sharing Conference on Hospital Safety 2006 (Hong Kong, 5 June 2006).
	Nakajima K. Educational Sessions: Risk management: an international look at a universal issue. A web-based incident reporting system with multidisciplinary collaboration for patient safety. Association for the Advancement of Medical Instrumentation 2005 Conference & Expo (Tampa, 17 May 2005).

Oral and Poster Presentations

	Nakajima K, Ikejiri T, Uema A, Dan H, Takahashi R, Marumi C, Tanaka H. Effectiveness of patient engagement in patient identification procedures in the outpatient departments of a Japanese university hospital [Poster Presentation]. International Forum on Quality and Safety in Healthcare 2014 (Paris, 8-11 April 2014).
	Takahashi R, Nakajima K, Dan H. Development of decision-making flowcharts on initial management of in-hospital falls [Poster Presentation]. International Forum on Quality and Safety in Healthcare 2013 (London, 16-19 April 2013).
	Ikejiri T, Uema A, Nakajima K, Takahashi R, Dan H, Marumi C, Nagahama M, Nishio M, Naka H, Ueno H, Nishihata A, Hashimoto A, Wakata T, Nakaue K, Komura M, Wakamatsu M, Hayashi M. Keys for the successful implementation of patient engagement programmes for Patient Safety [Poster Presentation]. International Forum on Quality and Safety in Healthcare 2013 (London, 17 April 2013).
	Nakajima K, Takahashi R, Uema A, Shimai Y. Introduction of non-technical skills to undergraduate patient safety education for medical and other healthcare students [Poster Presentation]. International Forum on Quality and Safety in Healthcare 2012 (Paris, 17-20 April 2012).
	Takahashi R, Nakajima K, Dan H, Iehira Y. Airway risk assessment:untapped patient safety issue in a muliti-disciplinary hospital [Poster Presentation]. International Forum on Quality and Safety in Healthcare 2012 (Paris, 17-20 April 2012).
	Ikejiri T, Uema A, Shimizu K, Takahashi R, Nakajima K, Dan H, Iehira Y, Nagahama M, Shimai Y. Nurses' recognition of patient engagement by a hospital-wide intranet questionnaire [Poster Presentation]. International Forum on Quality and Safety in Healthcare 2012 (Paris, 17-20 April 2012).
	Takahashi R, Nakajima K, Shimizu K, et al. Adoption of storytelling approach in patient safety education on procedural sedation during endoscopic interventions [Poster Presentation]. Association for Medical Education in Europe Annual Conference 2011 (Vienna, 31 August 2011).
	Nakajima K, Takahashi R, Uema A, Ikejiri T, Shimizu K, Dan H, Shinkai Y, Nagahama M, Ikebe Y. Development and implementation of a hospital-wide patient engagement programme with a culturally accepted tool in a Japanese university hospital [Poster Presentation]. International Forum on Quality and Safety in Healthcare 2011 (Amsterdam, 5-8 April 2011).
	Nakajima K, Takahashi R, Uema A, Ikejiri T, Shimizu K, Dan H, Shinkai Y, Nagahama M, Ikebe Y. Development and implementation of a hospital-wide patient engagement programme with a culturally accepted tool in a Japanese university hospital [Oral Presentation]. The First International Improvement Science Symposium (Amsterdam, 5 April 2011).
	Nakajima K. Special session dedicated to healthcare profesisonals in the disaster area：Live from Fukushima [Other Presentation]. International Forum on Quality and Safety in Healthcare 2011 (Amsterdam, 5-8 April 2011).
	Takahashi R, Nakajima K, Fujino Y. Pediatric in-hospital emergencｙ calls in a multi-disciplinary university hospital [Poster Presentation]. 6th World Congress on Pediatric Critical Care (Sydney, 14-17 March 2011).
	Nagahama M, et al. Results of health records audit of 40 Japanese university hospitals to develop documentation guidelines for physicians [Oral Presentation]. The International Federation of Health Records (Milano, 17 November 2010).
	Takahashi R, Nakajima K, Shinkai Y, et al. Integration of story-telling and simulation to promote rapid response in pediatric wards [Oral presentation]. Third International Paediatric Simulation Symposium and Workshops (Madrid, 30 September 2010).
	Takahashi R, Nakajima K, et al. Development of a course with integration of story-telling and simulation to promote rapid response in pediatric wards [Oral Presentation]. SimTect Health 2010 (Melbourne, 1 September 2010).
	Nakajima K, Takahashi R, Shimizu K, Dan H, Shinkai Y, Uema A, Ikejiri T, Nagahama M, Ikebe Y. Development of storytelling styled educational material to improve team performance for patient safety [Poster Presentation]. International forum on Quality and Safety in Health Care 2010 (Nice, 20-23 April 2010).
	Shimizu K, Nakajima K, Takahashi R, Irisawa T, Tasaki O, Fjino Y. Analysis of hospital-wide medical emergency system by intensive care specialists in a Japanese university hospital [Poster Presentation]. International forum on Quality and Safety in Health Care 2010 (Nice, 20-23 April 2010).
	Shimizu K, Nakajima K, Takahashi R, et al. Simulation of preparing emergency items in the patient safety round to improve emergency responses [Poster Presentation]. 10th Annual International Meeting on Simulation in Healthcare (Phoenix, 27 January 2010).
	Nakajima K, Takahashi R, et al. A hospital-wide M&M conference with multidisciplinary members in a Japanese university hospital [Poster Presentation]. International Forum on Quality and Safety in Healthcare 2009 (Berlin, 17-20 March 2009).
	Takahashi R, Nakajima K, et al. Pediatric in-hospital emergency management training: rapider response through simulation [Poster Presentation]. 9th Annual International Meeting on Simulation in Healthcare (Orlando, 12 January 2009).
	Nakajima K, et al. The use of e-learning in patient safety education [Oral Presentation]. International Forum on Quality and Safety in Healthcare 2008 (Paris, 25 April 2008).
	Nakajima K. Patient safety with information technology and multidisciplinary collaboration. Panel Discussions: Improving healthcare quality and reducing medical errors through multidisciplinary informatics approach [Oral Presentation]. The 9th International Congress on Nursing Informatics (Seoul, 12 June 2006).
	Nakajima K, et al. A hospital-wide approach to prevent medical adverse events using intranet-based incident reporting system [Poster Presentation]. 2nd Asian Pacific Forum on Quality Improvement in Health Care 2002 (Singapore, 11-13 September 2002).

Publications (English only)

Takahashi R, Nakajima K, Kogaki S, Shinkai Y, et al. Development of a course for patient safety with integration of story-telling and simulation to promote Rapid Response in pediatric wards. Simulation in Healthcare 2010;5(6):365.
Takahashi R et al. Effects of continuous venovenous hemofiltration on the pharmacology of Carperitide, a recombinant human atrial natriuretic peptide. Circ J 2010; 74: 1888-1894.
Shimizu K, et al. Synbiotics decrease the incidence of septic complications in patients with severe SIRS: a preliminary report. Dig Dis Sci 2009;54:1071-1078.
Nakajima K, Takeda H. The use of e-learning in patient safety education. QSHC 2008;17:e1.
Nakajima K, Kurata T, Takeda. A web-based incident reporting system and multidisciplinary collaborative projects for patient safety in a Japanese hospital. QSHC 2005;14:123-129.
Takeda H, Matsumura Y, Nakajima K, Kuwata S, Zhenjun Y, Shanmai J, et al. Health care quality management by means of an incident report system and an electronic patient record system. Int J Med Inform 2003;69:285-293.
Nakajima K, Keyes C, Kuroyanagi T, Tatara K. Medical malpractice and legal resolution systems in Japan. WMA 2002;48(2):20-28.
Nakanishi N, Sato M, Shirai K, Nakajima K, Murakami S, Takatorige T, Suzuki K, Tatara K. Associations between white blood cell count and features of the metabolic syndrome in Japanese male office workers. Ind Health 2002;40:273-277.
Nakajima K, Keyes C, Kuroyanagi T. Medical malpractice and legal resolution systems in Japan. JAMA 2001;285:1632-1640.
Nakanishi N, Nakamura K, Nakajima K, Suzuki K, Tatara K. Coffee consumption and decreased serum gamma-glutamyltransferase: a study of middle-aged Japanese men. Eur J Epidemiol 2000;16:419-423.
Ruhul A, Fukuda H, Nakajima K, Takatorige T, Tatara K. Public health services in Bangladesh with special reference to systems and trends of vital statistics. Environ Health Prev Med 1999;4(2):65-70.
Nakanishi N, Tatara K, Shinsho F, Murakami S, Takatorige T, Fukuda H, Nakajima K, Naramura H. Mortality in relation to urinary and faecal incontinence in elderly people living at home. Age Ageing 1999;28:301-306.
Nakanishi N, Tatara K, Nishina M, Nakajiama K, Naramura H, Yoneda H. Relationships of disability, health management and psychosocial conditions to cause-specific mortality among a community-residing elderly people. Journal of Epidemiology 1998;8(4):195-202.
Shinsho F, Tatara K, Nakajima K, Fukuda H, Nishi N, Takatorige T. Does prompt treatment of hypertension after blood pressure check-ups reduce morbidity of cerebrovascular disease?. Environ Health Prev Med 1998;2(4):151-156.
Nakajima K, Nakajima S, Okamura T, Shikanai S, Tatara K. Neurosurgical management of asymptomatic disease through a risk management lens: Basic knowledge of adverse events and medical malpractice litigation. Neurologica Medico-Chirurgica 1998;38:591-593.
Nakajima K, Tatara K, Nakanishi N. Assessment of the zinc turbidity test and the use of risk factors in detecting asymptomatic hepatitis C virus carriers: population based study. BMJ 1997;314:1169.
Fukuda H, Shinsho F, Nakajima K, Takahashi S, Tatara K. Oral health habits and the number of teeth present in Japanese aged 50-80 years. Community Dental Health 1997;14:248-252.
Nakajima K, Bisallion D. Communication issues in the managed care environment. Forum 1996;17(4):6-9.

Others

Nakajima K. Chair of the Program Committee of the 4th Annual Congress of Japanese Society for Quality and Safety in Healthcare (Tokyo, 21-22 November 2009).