thoughts of care services after experiencing patient 2015/5 須田泰司 （Yasuji Suda）
はじめに • 入院・手術をはじめて経験した、患者（わたし）から みた、ヘルスケアサービスの現状と問題意識およ び、改善アイディアを記します。 notes • I describe a field work of my first inpatient e xperience, and argue some issues and ideas about today’s healthcare service in Japan.
１ Accident 2014・7・1 • while I speeding up my bicycle, ⇒slipped, went out of control ⇒ hit severely left side of my body to the road A helmet protected my head! • sharp pain in my left shoulder and rib • a bump on my shoulder fractured ? swelled up ? Crash source (http://health.goo.ne.jp/medical/body/jin004 )
２ Buying medical service at clinic care events impressions ② Backing home, went to a ① First of all, Check my condition neighborhood clinic in neighborhood clinic A.S.A.P ③ a questionnaire was handed out ④ Filling the form is bothering ⑤ Counseled by a doctor ⑥ Look at the questionnaire, ⑦ Took X-ray photos please ⑨ Diagnosed：clavicle fracture and rib ⑧ So many photos ! bruise ⑩ Good news (Ribs are not ⑪ Procedure：traction treatment broken)
⇒failed ⑫ Recommended to have an operation ⑬ Oh ! I should take an ⑮ Made a referral and copied X-ray operation ? photos on CD ⑭ I do not have any information to ⑰ Ref e P rr a e id d h ou s t p o it fa p l i o s cak e g te f n eeral with 520 beds, select a hospital to refer. located 10 minutes walk from my home ⑯ No help to contact a refered hospital
２ Buying medical service at hospital care events impressions Backing home, I should make a call for reservation ② hospital arranged counseling to ① a little bit awesome day ③ luckily, I get counseling today ④ to a referred hospital’s grand rec ⑤ reception was closed ! eption then reception what should I do ? ⑥ fill a questionnaire ⑦ almost same questions again ⑧ have a counseling ⑨ make same explanation again ⑩ took X-ray and CT images ⑪ diagnosed: dismal clavicle fractu ⑫ CT images are amazing! clavicle re and rib fracture was broken in and 3 ribs were ⑬ explain about operation cracked ⑮ proceed for hospitalization ⑭ so sad . there is a risk that left
arm are unable to move as well as
before ⑯ pay the bill, back home then pur chase prescription
２ Buying medical service at hospital care events impressions ①Day １：Thursday • boring。。。There are so many ★counseling for surgery wheelchair patients （doctors , nurses and staffs） • if I bleed some parts of my body, an ② Day ２：Friday op. may be postponed to avoid ★ preparation infection （check might be too late ） ★surgery（open reduction and i • ！lay down to an op. table by myself nternal fixation ３ hours） • anesthesia is so awful。。。 ★ after care（counseling, IV, ch • so little pain on my surgery point, eck stitches） heavy ache on my back ③ Day ３：Saturday • walking around by myself is great ★ after care（IV, check stitches） • why not to accept payment ? ★practice for self-care（put on a I unconsciously put stress on my nd off the protector） back to protect fractured parts ★sign a paper swearing paymen ⇒led to heavy ache on my back t ⇒led to sleep interruption
２ Buying medical service at hospital care events impressions ④ Day ４：Sunday ・ In my condition, not to move ★discharged in AM and put stress on upper left backing home and start self-care arm and shoulder, alone ⇒took some minutes to get up ⑤ ２ weeks later, off the stitches ⇒could only wear open shirts ⑥ ２ months later, off the protector ⑦ ３ months later, permitted for da ily motion. ⑧ ４ months later, permitted for sp ort activity. ⑨ １ year later（2015/7 ）, will have a surgery to remove joint plate I am a right-hander
３ Findings through a field work as a inpatie nt ①clinic only issued referral. ⇒not provide scheduling support for patient (Me) clinic
（check） ②I, acute patient did not have any information about （procedure） quality of care for referral hospitals. hospital Also, not have enough knowledge to judge a severity of my condition. （re-check） ①nurses were so busy than I imagined. （operation） ⇒battling with so many tasks（monitoring vitals, IV, handling nursing calls, and so on） （follow ②eating time was so little just like fast food -up） self care ⇒swallowing than chewing
③payment was not smooth ⇒my discharge was scheduled on Sunday, hospital can not accept any payment including credit cards. Instead, They required me to sign a paper that I ①No living support services after discharge swear definitely to pay. ⇒ Implicitly, such services should provide by family member. So single liver face difficulties without any help .
３ Findings through a field work as a inpatient （１）In my case, patient info. was not exchanged in area health info. network. ⇒Transferred info. are images in a CD and a paper referral. That’s all. （２）I could not judge my medical condition right to my first experience. Also, it is very difficult to explain properly with my words . ⇒3D images by CT was more than the words ! Diagnosed rib bruise in clinic appeared to rib fracture. ⇒in case of acute medical condition that anyone never experienced before, patient rational behavior is to go hospital directly. （３）”patient centered care” only practices in each medical silo (facility). ⇒care is provided by each medical facility without coordination but clinic hospit home all c Parte i ep n rto ce ce ss nte co re n d si c s a trs e o i n s e patient experience. only applied under care al care public health insurance care All experience is care for my fracture ⇒In my view, each service is irritative as they were not coordinated !
３ Findings through a field work as a inpatie nt directly go to a hospital
⇒ ratonal patent behavior Admission data copy for hospital drug fee checkup images procedure transfer & waiting time care pts care pts at hospital at clinic ◆a hospital reimbursement from 4,045 2,986 Cost public health insurance was Total Service points pts×10 1.3times larger than a clinic. 7,031 \70,310 ◆I was charged \3,ooo if I directly go to a hospital without a referral.
le ss m one y, \3,000 hospital charge is
mo re mo ney,
le ss val ue
smaller than a out of pocket
mo re val ue
fee（\8,960） at a clinic.
A plan raising hospital charge
One stop service at \5,000－\10,000 to reduce direct use.
４ Conclusion and implication In my case, present healthcare service lack a design concept of UX. • clinic to hospital network and UX – Networked health service did not include information network. ⇒ I wrote paper questionnaire twice a day. ⇒Online data exchange did not take place in central Tokyo area yet. – Coordinated network only handled patient data partially. – No counseling, no information to decide referral hospital by myself . ⇒As such, I wholly depended on a clinic doctor’s decision. ⇒Providing (matching) information for hospital is effective ? – Medical clerks in hospital dedicated to manage service for patient. • public health insurance and support service after discharge p eriod – I could not find any support services after discharge. ⇒Care service was designed for provider, not for patient. ⇒So combining public health service with out of pocket service after disc harge is important to create more value for patient .
４ Conclusion and implication～an idea using ICT data copy First for hospital
u c l i n i c procedure ＜Now＞ se f
i e ma h o s p i gtea l Facility e ch s ec drug base k ch u ecpk Change medical fee Transfer to patient base wil calculation from facility integrate be possible to combine data base to patient base with a referral ＜future> patient First check images procedure drug
e fee ⇒⇒ procedure necessary ⇒
Dismal fracture （traction treatment） unneeded⇓ ⇒⇒ open operation necessary source：http://遠隔画像診断.jp/archives/15755 Reject ・avoid unneeded care ⇐ payment ・optimizing care process Looking service process from patient claim base will lead to identify avoidable care cost. In this case, It is a procedure at clinic.