Complete Explanation of Medical Fee Revisions for Hospital Executives: Reading the Future of Hospital Management, Part 27
Part 27: Is that management meeting really necessary? Why hospitals that only report numbers cannot change
The reason why hospitals do not change even though the numbers are ready
When attending a hospital management meeting, I sometimes encounter a strange scene.
The administrative director reads out the monthly results: "This month's medical revenue is 98% compared to the same month last year," "The bed occupancy rate was 87.2%," "The number of outpatient visits has decreased by 3.5%," "Personnel costs exceeded the budget."
The hospital director asks: "Why did the number of patients decrease?"
The person in charge replies: "It is thought that the number of patients in the entire region is decreasing."
And in the end, it finishes with
"Let's continue to monitor the situation."
and ends.
The next month, they repeat almost the same story.
The materials are impressive. The numbers are all there. The executives are in attendance.
Even so, the hospital does not change.
The reason is very simple.
It is because they are only reporting numbers and deciding nothing.
■ Has your management meeting become a "monthly report meeting"?
In many hospitals, numbers are checked at monthly management meetings.
Medical revenue, inpatient/outpatient revenue, bed occupancy rate, number of patients, personnel costs, material costs
Looking at the numbers themselves is correct.
However, the problem is what happens after that.
For example, suppose
"the bed occupancy rate dropped from 90% to 84%."
In a meeting that is just for reporting, it ends with:
"It dropped," "The number of patients is decreasing," "We will continue to monitor it next month."
However, what should really be discussed is what comes next.
Why did it drop?
Did new admissions decrease? Did emergency admissions decrease? Did referred patients decrease? Was there a bottleneck in discharges? Were there any bed closures?
Depending on the cause, the countermeasures are completely different.
Numbers are not the answer.
Numbers are the entrance that shows "what should be asked next."
The first thing I look at in a management meeting is the "difference"
In management meetings, I do not look only at the figures for a single month.
What I look at is
how much of a variance there is compared to what.
Comparison with the previous year, comparison with the budget, comparison with the previous month, comparison with the plan.
Even if medical revenue is 1 billion yen, that alone cannot be evaluated.
If the budget is 950 million yen, it is an upward deviation. If the budget is 1.05 billion yen, it is a shortfall.
And the most important thing is
why there is a 50 million yen variance.
Is it the number of patients? Is it the unit price? Is it bed turnover? Is it the number of surgeries? Is it the composition of medical departments?
Only by breaking it down to this level can management decisions be made.
We do not look at the numbers, but at the variance in the numbers and the reasons for them.
In meetings where the causes are ambiguous, the countermeasures will also be ambiguous.
There are phrases often heard in hospital management.
“Patients have decreased,” “Personnel costs have risen,” “Material costs have increased.”
At first glance, these sound like causes, but most are just “phenomena.”
If patients have decreased, why did they decrease?
Did referrals decrease? Did we turn away emergency patients? Was there a doctor resignation? Did the number of clinic days decrease? Is it the regional population?
If personnel costs have risen, why did they rise?
Is it an increase in hiring? Is it an increase in overtime? Is it reliance on temporary staff? Is it the night shift system? Is it a wage increase?
While leaving the causes ambiguous,
saying “Let’s increase patients” or “Let’s curb personnel costs”
will not move the front lines.
The role of a management meeting is
to break down problems into an “actionable size.”
■ A management meeting where no one disagrees is dangerous.
The hospital director says,
“Let’s accept more emergency patients.”
Everyone nods.
However, can we really accept them?
Are there enough night-shift nurses? Can we secure on-duty doctors? Are there empty beds? Is discharge support functioning? Will the front lines break down?
In a proper management meeting,
“That policy is difficult with the current staff,”
“We should improve discharge support first,”
“This investment cannot be recovered.”
It is perfectly fine for opposing opinions to be raised.
In fact, it is more dangerous if they are not.
There are also meeting management techniques, such as assigning someone the role of 'devil's advocate' to intentionally speak from an opposing viewpoint.
Management meetings are not rituals to confirm the hospital director's policies.
They are forums for clashing different perspectives to improve the quality of management decisions.
The most important thing in a meeting is 'who will do what, and by when'.
I always confirm three things at the end of a management meeting.
Who will do it By when will they do it What constitutes completion
'Increase referred patients' is too weak.
Instead, we decide as far as:
'The regional liaison office manager will analyze the top 10 medical institutions with declining referrals by the end of this month.'
We define it to this extent.
Furthermore, we even set:
'Report the reasons for the decline and the countermeasures at next month's meeting.'
We go that far.
A management meeting is a 'place for making decisions,' not a 'place for reporting.'
30 minutes of decision-making creates more value than a 90-minute meeting.
I propose dividing management meetings into four parts.
Confirmation of previous decisions
Confirmation of significant variances
Identification of causes
Decision-making
(For example, 5 minutes for reporting, 20 minutes for discussion, 5 minutes for decision-making)
The important thing is not to read every single number.
It is to spend time on the numbers that require management judgment.
■ Hospitals where the director decides everything are also dangerous
Hospitals with an overly talented director can move quickly in the short term.
However,
The director becomes exhausted.
Executives do not develop.
Staff on the front lines stop making judgments.
Management stalls in the director's absence.
These are the risks involved.
Management meetings are not a place to increase the burden on the hospital director.
They are a place to build the capacity for organizational decision-making.
Neither management accounting nor budgeting has any meaning if they are not used in meetings.
Part 25: Management Accounting, Part 26: Budget Management
Both are important, but creating them alone will not change the hospital.
Use numbers in meetings.
Identify the differences.
Ask about the causes.
Decide on countermeasures.
Verify the results the following month.
Only with this cycle do numbers become management.
Finally—is that management meeting really necessary?
If every month you
create impressive materials, gather many executives, report the same numbers, and finally end with
“Let’s continue to monitor the situation,”
then...
It might be worth reconsidering once.
Is that management meeting really necessary?
Numbers are not there to be reported.
They are there to be used for making decisions.
A hospital does not change when the numbers change.
It changes when the management looks at the numbers and changes how they make decisions.
■ Next Issue Preview (Part 28)
Next time, we will cover “Hospitals that have numbers but cannot decide: The structure of organizations with slow decision-making.”
Hospitals are more complex than general companies. Doctors, the nursing department, the medical office, the board of directors, the community—multiple dynamics are intertwined. That is precisely why
a structure where even talented people cannot make decisions is created. In Part 28, we will unravel that structure.
I share information on medical and nursing management support and M&A support. Please follow me to receive new articles.
FY2026 Medical Fee Revision for Hospital Executives
“Hospital Selection” Series
Part 1: The 'Hospital Selection' Begun by the FY2026 Revision—The Difference Between Hospitals That Survive and Those That Struggle
Part 2: Initial Consultation Fees Have Risen. The Real Reason Hospital Management Is Still Getting Tougher
Part 3: Price Adjustment Fees Are Not Enough—The Quiet Limit Reached by Hospital Management
Part 4: People Are Disappearing from Hospitals That Cannot Raise Wages—The Reality Forced by the FY2026 Revision
Part 5: Hospital Disparities Widen with Regional Comprehensive Medical Wards—Hospitals That Grow and Hospitals That Struggle
Part 6: What Hospitals Fixated on Medical DX Additions Are Overlooking
Part 7: How Will Hospitals Survive in an Era Where Nurses Cannot Be Recruited?
Part 8: Hospitals That Use AI vs. Hospitals That Do Not—The Management Gap That Will Open in 5 Years
Part 9: Paper Culture Is Hurting Hospitals—The Hospital Operations Demanded by the FY2026 Revision
Part 10: Toward an Era Where 'Hospitals That Can Perform Surgery' Survive—Surgical Capability Becomes the Turning Point
Part 11: Hospitals That Cannot Accept Elderly Emergency Patients Will Be Left Behind
Part 12: The Reason Why Management of Regional Comprehensive Care Wards Suddenly Becomes Difficult
Part 13: Hospitals That Will Remain Until 2040 and Those That Will Disappear—This Revision Was a Preview, 'I Especially Want Small and Medium-Sized Hospital Directors to Read This'
Part 14: The Day When Remaining an Acute Care Hospital Becomes the Greatest Risk
Part 15: The Wards Are Full but There Is No Profit—The Culprit Was 'Exit Congestion'
Part 16: Toward an Era Where Convalescent Rehabilitation Wards Are Chosen Based on 'Results'
Part 17: What Has Changed in DPC Standard Hospital Groups 1 and 2—Coefficient Differences Create Revenue Disparities
Part 18: Hospitals That Cannot Coordinate with Nursing Care Will Not Be Chosen—The Strength of Hospitals with Discharge Destinations
Part 19: The End of Hospital-Complete Medical Care—The Reason the FY2026 Revision Steered Toward Home Care
Complete Guide to Medical Fee Revisions for Hospital Executives: Reading the Future of Hospital Management
Part 20: What Do Hospitals Earn Money From in This Era? 'Structural Reform of Profits' Is More Important Than Medical Fee Revisions
Part 21: 'Unprofitable Hospitals' Have Common Traits: The Numbers I Look at First During Business Turnarounds
Part 22: It Is Too Late to Turn a Hospital Around 'After It Goes Into the Red': Danger Signals Appear in the Numbers
Part 23: Why Some 'Profitable Hospitals' Are Still at Risk: Hospital Management Viewed Through Cash Flow
Part 24: The Less a Hospital Director Can Read Financial Statements, the More Dangerous the Hospital Is: Why Hospitals Can Fail Even When Profitable
Part 25: The Power of 'Management Accounting' That Directors Don't Know: Hospital Management Changes with Departmental Profitability
Part 26: Why Do Hospitals Lack 'Budgets'? The Real Reason They Repeat the Same Mistakes Every Year
Part 27: Is That Management Meeting Really Necessary? Why Hospitals That Only Report Numbers Cannot Change
Part 28: 'Hospitals That Have Numbers but Cannot Make Decisions': Common Traits of Organizations with Slow Decision-Making
Part 29: What Should Be Changed First in a Hospital Turnaround? Look at the 'Structure' Rather Than Cuts
Final Part (Part 30): Where Is Hospital Management Headed After the 2026 Revision? The Conditions for 'Surviving Hospitals' Seen After Writing 30 Parts