Investigation of the medical staffs stress reduction program for malpractice prevention

• Project/Area Number: 14570359
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Single-year Grants
• Section: 一般
• Research Field: Public health/Health science
• Research Institution: Tokyo Medical University
• Principal Investigator: SHIMOMITSU Teruichi Tokyo Medical University, Department of Medicine, 医学部, 教授 (90206243)
• Co-Investigator(Kenkyū-buntansha): USUI Masahiko Tokyo Medical University, Department of Medicine, 医学部, 教授 (40074570) ; YUKIOKA Tetsuo Tokyo Medical University, Department of Medicine, 医学部, 教授 (00182668) ; ODAGIRI Yuko Tokyo Medical University, Department of Medicine, 医学部, 講師 (90276907) ; OHYA Yumiko Tokyo Medical University, Department of Medicine, 医学部, 講師 (00074724) ; 石丸 新 東京医科大学, 医学部, 教授 (50112785) ; 小柳 泰久 東京医科大学, 医学部, 教授 (20074560)
• Project Period (FY): 2002 – 2004
• Project Status: Completed (Fiscal Year 2004)
• Budget Amount: ¥3,500,000 (Direct Cost: ¥3,500,000); Fiscal Year 2004: ¥1,300,000 (Direct Cost: ¥1,300,000); Fiscal Year 2003: ¥800,000 (Direct Cost: ¥800,000); Fiscal Year 2002: ¥1,400,000 (Direct Cost: ¥1,400,000)
• Keywords: Malpractice / Stress / Risk management

Research Abstract

Many recent malpractice reports in large hospitals in Japan made "patient safety practice" the most urgent issue in medical field. Establishment of system for patient safety is important for risk management. At the same time, without health management of medical workers, who work under poor labour conditions, we can not prevent malpractice due to human errors. It is critical to assess the stressors and stress responses of medical workers and to conduct appropriate stress management for the prevention of malpractice and the assurance of quality in medicine.
We assessed stress levels of medical doctors and nurses in hospitals by investigating the working conditions, experiences of incidents/accidents, job stress, burn-out index and so on for the 1^<st> year. We found significant differences in the factor scores of stressors, stress response and modifiers between those who had experienced incidents/accidents within 6 months and those who did not among nurses, but not among medical doctors.
We developed a stress reduction program for nurses including a "active listening class", in which they could learn communication skills for the improvement of nurse-nurse relationships, nurse-patient relationships, or nurse-doctor relationships. We also developed methods for coping with stress and distributed manuals for coping with stress for the 2^<nd> year. We conducted a randomized control trial to assess the stress reduction program and evaluate it six months after the intervention. However, many of the stress level scores deteriorated in both the intervention groups and the control groups due to a factor outside of intervention, that is, alleged gross malpractice in the hospitals that underwent intervention. As to the burn-out index, the factor scores of private burn-out and client related burn-out significantly increased in the control group but did not change in the intervention group(interaction p=0.081, and p=0.062, respectively).
We only evaluated the strategy to improve stress responses by the stress reduction programs as mentioned above, but due to various reasons, could not conduct the program which also includes the methods to improve stressors.
In conclusion, the stress reduction program which we have developed may be effective as we found significant changes in burn-out index between intervention groups and the control group.