The Ministry of Health, Labour and Welfare started the Project to Enhance the Quality of Medical Care by subsidizing 3 hospital organizations in FY 2010. In this endeavor the Japan Hospital Association (JHA) was designated as one of them to undertake the project, in which 30 hospitals took part. When one-year predetermined term ended, the Japan Hospital Association decided to continue the project and set up the QI Committee.

In FY 2011, the project involved all the 85 hospitals that expressed willingness to participate. Eleven quality indicators, including patient satisfaction and the death rate of inpatients just like those in the MHLW’s project a year before, were calculated and disclosed on JHA website. Different quality indicators are to be used for the hospitals with psychiatric beds/beds for long-term care.

Quality indicators in general, are often used to make a horizontal comparison as benchmarks for hospitals. However, I would think it should not be the case, at least as a primary objective. In a situation where the method of adjusting confounding factors deeply associated with the role and function of respective hospitals, local characteristics, and patient attributes has not been elaborated to a satisfactory level at the moment, many of the quality indicators are not suitable for the inter-hospital comparison of the quality of medical care.

Therefore, I believe that the primary objective of the QI Project is that “each hospital makes every effort, based on quality indicators over time, for improvement in the quality of medical care.” When a hospital discloses the information on its performance expressed in values, hospital staffs are highly motivated to improve their performance.

I would think that this kind of project, i.e., measuring and disclosing the quality of medical care, is basically an activity that should be promoted by the national government, as in other countries. In the United Kingdom and other countries, a P4P (Pay for Performance) system is adopted, in which general practitioners and hospitals that have met certain level of quality indicators are rewarded with additional medical service fees. I wonder if it is high time for Japan to implement a national policy to measure and disclose quality indicators in respective institutions.

Tsuguya Fukui
Chair, Quality Indicator Committee