The association of long working hours and short sleep duration on mental health among Japanese physicians.

This cross-sectional study investigate the association between long working hours, short sleep duration, and mental health among Japanese physicians. We enrolled 232 Japanese physicians. We used the Brief Job Stress Questionnaire to assess high-stress status, and the Japanese version of the Center for Epidemiologic Studies Depression scale to assess depressive status. Daily sleep duration (DSD) and weekly working hours (WWHs) were collected using a self-administered questionnaire. Multivariable-adjusted logistic regression analysis was performed to examine the association of the combined categories of DSD and WWHs with high-stress and depressive status. Compared to physicians with WWHs <80 h and DSD ≥6 h, the multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of high-stress status for those with WWHs ≥80 and DSD ≥6, WWHs <80 and DSD <6, and WWHs ≥80 and DSD <6 were 2.76 (0.97-7.87), 3.36 (1.53-7.40), and 3.92 (1.52-10.14), respectively. The respective ORs (CIs) of depressive status were 1.82 (0.42-7.81), 4.03 (1.41-11.53), and 4.69 (1.33-16.62). The results showed that regardless of working long hours or not, physicians with DSD <6 h had significantly higher stress and depressive status, suggesting that not only regulating long working hours but also ensuring adequate sleep duration is important for preventing physicians' mental health.

Working hours of full-time hospital physicians in Japan: a cross-sectional nationwide survey.

BACKGROUND: The culture of excessively long overtime work in Japan has not been recently addressed. New legislation on working hours, including a limitation on maximum overtime work for physicians, will be enforced in 2024. This study was performed to elucidate the working conditions of full-time hospital physicians and discuss various policy implications. METHODS: A facility survey and a physician survey regarding physicians' working conditions were conducted in July 2022. The facility survey was sent to all hospitals in Japan, and the physician survey was sent to all physicians working at half of the hospitals. The physicians were asked to report their working hours from 11 to 17 July 2022. In addition to descriptive statistics, a multivariate logistic regression analysis on the factors that lead to long working hours was conducted. RESULTS: In total, 11,466 full-time hospital physicians were included in the analysis. Full-time hospital physicians worked 50.1 h per week. They spent 45.6 h (90.9%) at the main hospital and 4.6 h (9.1%) performing side work. They spent 43.8 h (87.5%) on clinical work and 6.3 h (12.5%) on activities outside clinical work, such as research, teaching, and other activities. Neurosurgeons worked the longest hours, followed by surgeons and emergency medicine physicians. In total, 20.4% of physicians were estimated to exceed the annual overtime limit of 960 h, and 3.9% were estimated to exceed the limit of 1860 h. A total of 13.3% and 2.0% exceeded this level only at their primary hospital, after excluding hours performing side work. Logistic regression analysis showed that male, younger age, working at a university hospital, working in clinical areas of practice with long working hours, and undergoing specialty training were associated with long working hours after controlling for other factors. CONCLUSIONS: With the approaching application of overtime regulations to physicians, a certain reduction in working hours has been observed. However, many physicians still work longer hours than the designated upper limit of overtime. Work reform must be further promoted by streamlining work and task-shifting while securing the functions of university hospitals such as research, education, and supporting healthcare in communities.

Annotation Guidelines for Medication Errors in Incident Reports: Validation Through a Mixed Methods Approach.

At present no adequate annotation guidelines exists for incident report learning. This study aims at utilizing multiple quantitative and qualitative evidence to validate annotation guidelines for incident reporting of medication errors. Through multiple approaches via annotator training, annotation performance evaluation, exit surveys, and user and expert interviews, a mixed methods explanatory sequential design was utilized to collect 2-stage evidence for validation. We recruited two patient safety experts to participate in piloting, three annotators to receive annotation training and provide user feedback, and two incident report system designers to offer expert comments. Regarding the annotation performance evaluation, the overall accuracy reached 97% and 90% for named entity identification and attribute identification respectively. Participants provided invaluable comments and opinions towards improving the annotation methods. The mixed methods approach created a significant evidential basis for the use of annotation guidelines for incident report of medication errors. Further expansion of the guidelines and external validity present options for future research.

How do healthcare practitioners use incident data to improve patient safety in Japan? A qualitative study.

BACKGROUND: Patient incident reporting systems have been widely used for ensuring safety and improving quality in care settings in many countries. However, little is known about the way in which incident data are used by frontline clinical staff. Furthermore, while the use of a systems perspective has been reported as an effective way of learning from incident data in a multidisciplinary team, the level of adaptability of this perspective to a different cultural context has not been widely explored. The primary aim of the study, therefore, was to investigate how healthcare practitioners in Japan perceive the reporting systems and utilize a systems perspective in learning from incident data in acute care and mental health settings. METHODS: A non-experimental, descriptive and exploratory research design was adopted with the following two data-collection methods: 1) Sixty-one semi-structured interviews with frontline staff in two hospitals; and 2) Non-participatory observations of thirty-seven regular incident review meetings. The two hospitals in the Greater Tokyo area which were invited to take part were: 1) a not-for-profit, privately-run, acute care hospital with approximately 500 beds; and 2) a publicly-run mental health hospital with 200 beds. RESULTS: While the majority of staff acknowledge the positive impacts of the reporting systems on safety, the observation data found that little consideration was given to systems aspects during formal meetings. The meetings were primarily a place for the exchange of practical information, as opposed to in-depth discussions regarding causes of incidents and corrective measures. Learning from incident data was influenced by four factors: professional boundaries; dealing with a psychological burden; leadership and educational approach; and compatibility of patient safety with patient-centered care. CONCLUSIONS: Healthcare organizations are highly complex, comprising of many professional boundaries and risk perceptions, and various communication styles. In order to establish an optimum method of individual and organizational learning and effective safety management, a fine balance has to be struck between respect for professional expertise in a local team and centralized safety oversight with a strong focus on systems. Further research needs to examine culturally-sensitive organizational and professional dynamics, including leader-follower relationships and the impact of resource constraints.

How to facilitate a rapid response system in Japan: a promotion course based on TeamSTEPPS.

AIM: In Japan, the number of facilities introducing a rapid response system (RRS) has been increasing. However, many institutions have had unsuccessful implementations. In order to implement RRS smoothly, a plan that meets the needs of each hospital is needed. METHODS: Rapid response system teams from each hospital, including a physician and staff in charge of medical safety, from the RRS online registry were invited to attend a workshop. The workshop aimed to develop and implement RRS. The course curriculum was based on the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) developed in the USA. Participating facilities were required to formulate an RRS introduction plan referring to Kotter's 8-step change model to overcome barriers in the implementation of RRS. The change in medical emergency team activations comparing the intervention and control group hospitals was compared. RESULTS: Sixteen institutions were eligible for this study. After participating in the workshop, there was a tendency toward more frequent activation of medical emergency teams in the intervention group (P = 0.075). According to a self-evaluation from each facility, there is great difficulty in overcoming the 5th step of Kotter's model (empower people to act the vision). CONCLUSION: This step-by-step evaluation clearly identified a problem with implementation and provided measures for resolution corresponding to each facility. There was a major barrier to overcome the 5th step of Kotter's model in leading change, which represents the attitude toward implementing RRS in institutions.

Association of lung function with atherosclerotic risk factors among Japanese Americans: Seattle Nikkei Health Study.

1. Impaired lung function has been reported to be associated with mortality from all causes, cardiovascular disease (CVD) and aortic pulse wave velocity (PWV). The aim of the present study was to examine the association between impaired lung function and atherosclerotic risk factors, including PWV, blood pressure, lipids, smoking and alcohol intake, among Japanese Americans. 2. The study subjects were 678 adult Japanese Americans who participated in CVD screening conducted under the Seattle Nikkei Health Study. Subjects with abnormal lung function were defined as those with forced vital capacity (FVC%) < 80% of predicted or forced expiratory volume in 1 s (FEV1%) < 80% of predicted. We conducted logistic regression analyses by using abnormal lung function as dependent variables. 3. The significant predictors positively associated with abnormal FVC% were age (60 years or older) and hypertension. Being a current drinker or an ex-drinker was independently and negatively associated with abnormal FVC%. The significant predictors positively associated with abnormal FEV1% were age (60 years or older), sex (male), hypertension and being a current smoker. Being a current drinker was independently and negatively associated with abnormal FEV1%. 4. In conclusion, the present study does not support the previously reported association of abnormal lung function with PWV. However, our findings imply that light and moderate drinking may be a protective factor of lung function and that hypertension and smoking may impair lung function.