A Hospital Director Training Program!? What I Saw After Becoming a Deputy Director.
Looking back now, this choice was
one of the biggest dilemmas of my life.
I was letting go of the career I had built as an emergency physician,
leaving the unknown clinical setting of a community-based integrated care ward,
and departing from Kamogawa City and Kameda, which had become my home.
I was completely lost.
Even so,
“The path no one takes will eventually become a path for someone else” (perhaps).
Thinking that, I will tell you the story of how I took that first step.
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The sense of discomfort I felt in the next stage after emergency medicine
When I was working as an emergency physician,
as in the previous article,
I wondered what I should do if I were to move on.
The path of further deepening my expertise in acute care
was the most promising and desirable option.
However,
I felt a certain sense of discomfort
in pursuing only acute care.
I, who wanted to treat everything,
was I really becoming a doctor who treats everything?
I thought about it after my grandmother's death.
Home care,
living in the community,
and the process of passing away.
I had hardly been involved in any of it.
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Moving into the community changed my perspective
Through my training in home medical care,
the time I spent outside the hospital increased.
By visiting patients' homes,
talking with patients and their families,
observing their daily lives, treating their illnesses, and seeing their family backgrounds,
I realized quite realistically
that medical care
is something that is
integrated into the lives of the community.
On the other hand, however,
I learned that in the field of home medical care,
medical care alone cannot fully solve
the root causes of the problems occurring.
• Family members live far away, making family discussions difficult at times
• Further support for “daily life,” not just medical care, is needed
• I want to monitor progress through hospitalization, but there are high hurdles for both the hospital and the patient
・Hospital side: Is there an indication for admission?
・Patient side: I can't be hospitalized because I have a pet...
• There is a strong attachment to the home they are used to, making it hard to accept moving to a facility
• Emergency patients who were transported out of necessity because home care was difficult
Emergency medicine and home care are often said to be “polar opposites,” but
for me, I began to think that the regional issues faced in emergency medicine and home care
are actually quite related.
⸻
“Isn't it meaningless if only this hospital improves?”
Naturally, my interest
shifted from the perspective of wanting to improve the patients transported to the emergency room,
wanting to improve the emergency department,
and wanting to make the hospital one that the community needs,
to gradually expanding to the entire region.
What will happen to the Minamiboso region
in the future?
And,
when I looked at the surrounding hospitals,
I began to feel strongly.
To ensure health on a broad scale,
even if only this hospital works hard,
if the surrounding medical institutions are weak,
if care such as nursing and welfare is insufficient,
community medicine will ultimately not function well.
Conversely,
if the surrounding regional hospitals, care, and municipal services
improve little by little,
wouldn't this entire region become much more livable?
I began to think that way.
⸻
The trigger was a trip to Ise Jingu
Around that time,
an article I happened to see
was about Shima Municipal Hospital and Dr. Yuta Esumi.
When I searched for terms I was curious about, such as
“emergency medicine, general practice, hospital management, regional revitalization, community building,”
it hit by chance.
At that time, I think my impression was just,
“There's an interesting person out there.”
A few years later, while on a trip to Ise Jingu,
Dr. Yuta Esumi suddenly appeared in a Facebook tag,
and I suddenly remembered that article
and reached out on social media saying “Nice to meet you.”
Then,
in an unexpected turn of events, before I knew it,
that night, we were drinking together at an izakaya in Toba.
⸻
“How about a hospital director training program?”
Naturally, one day of my trip turned into a hospital tour.
I was an acute care physician and a resident of Minamiboso,
and I never thought I would work at this hospital.
However, there was something that stuck with me from my conversation with Dr. Esumi.
“I believe that rural municipal hospitals
need young, motivated leaders.
People who can look not only at the hospital but also at the community.
I want to properly train people who aim to be such hospital directors.
Why don't you try it as a first-generation student?”
At the time, I honestly didn't really understand what would be involved.
But before I could think about it with my head,
my honest feelings came out.
This might be really interesting.
⸻
The first wall I hit as a deputy director
――“I want to increase the number of rehabilitation staff.”
Two years after that meeting,
after much hesitation, I had moved to Shima City.
After I started getting involved as a deputy director,
there was a topic that came up relatively early on.
“I want to increase the number of rehabilitation staff.”
If you looked at the site,
it was a very natural proposal.
There are many patients.
The staff is exhausted.
If rehabilitation is improved,
community-based integrated care will also become easier to manage.
At first, it was simply
“Let's increase them!”
and we started moving.
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The uniqueness of municipal hospitals
However, as I had no experience with municipal hospitals,
this was not as simple as I had thought.
• The staffing quota for rehabilitation staff is fixed
• There is no budget to begin with
• The hospital is in the red
• Personnel costs cannot be easily increased
• If we want to increase staff, we need to explain it to the mayor
Nothing moves
based solely on whether it is "good" or not.
Here, I was confronted with the reality that municipal hospitals
are built not just on the front lines, but on the foundations of systems, numbers, administration, and the judgment of residents.
In this way, starting with rehabilitation,
in addition to departments like nursing, administration, radiology, laboratory, pharmacy, and the medical staff office,
I ended up learning more about management strategy, medical safety, municipal cooperation, and community activities.
There are also arguments that municipal hospitals are unnecessary.
However, should we stop providing medical care in unprofitable areas where revenue is difficult to generate
just because it doesn't make money?
As a deputy director of a municipal hospital,
this is a major challenge I will have to face from now on.
(More on this in another article...)
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Taking responsibility and making decisions
Through this experience, what I felt was,
the job of a hospital director
might not just be about continuing to choose the right answer,
but about taking responsibility and making decisions.
That is what I have come to think.
What is right for the front lines.
The reality of management.
The judgment of the administration.
All of these are important,
and none of them are wrong.
But,
in most cases, there is no "correct answer" at this moment
that satisfies everyone.
In the midst of that,
faced with imperfect options,
I decide "we will go with this,"
stand in the line of fire, and accept the results.
I realized that is
the essence of the role of a hospital director.
The meaning of being involved in management at a young age
Being involved in hospital management at a young age
was not all fun.
But,
my perspective, field of view, and standpoint definitely changed.
In addition to the perspective of looking at each patient,
I had to look at the entire hospital
and the entire region
at the same time.
Things that I couldn't see
when I was only doing clinical practice
became clearly visible.
This was a lesson
that could not be gained from any book
or classroom learning.
Someone has to stand on the "driving side"
When thinking about regional medical care in various areas,
there is something I cannot help but think.
Among doctors (medical professionals),
someone is needed who can look at and
drive not just patients,
but the entire hospital and the entire region.
Not everyone needs to do it.
But,
if no one does it,
nothing will move forward.
This experience made me feel the importance of that 'someone' very deeply, and
it also made me feel that 'I want to be that someone, or support them.'
The perspective of 'not relying on superstars'
But finally, I would like to share one
paradoxical story.
As I travel across the country,
that 'someone' is always a charismatic superstar.
And I hope that many such superstars
will emerge across the country.
However, can regional healthcare
really be sustainable if it depends on an environment where
'it won't work without a superstar who can keep working in the region'?
That is the question.
It is paradoxical, but
the importance of regional healthcare lies in its sustainability.
I believe it is equally important to create systems and learning frameworks
that do not rely entirely on special talents or sacrifices for the role of hospital director.
In conclusion
I am often asked, but
I did not have the intention of 'wanting to become a hospital director.'
But,
how to connect the countryside and the hospitals there
to the future.
That question
became a very important theme for me.
The experience of diving into the field of
hospital management at a young age
has undoubtedly
become my nourishment.
'As a first-generation member of the hospital director program, why don't you give it a try?'
If it weren't for those words,
I don't think I would be who I am today.
This program is still ongoing, and
I think it would be great if we could expand it nationwide.
If you are interested, I look forward to your comments or messages.